♦^^'♦♦♦'•E 



i LIBMYO^CONGRESS. * 

*UNITElTsTATES OF AMERICA.* 



CLINICAL 



ELECTRO-THERAPEUTICS, 



MEDICAL AND SURGICAL: 



A HAND-BOOK FOR PHYSICIAN'S IN THE TREATMENT 
OF NERVOUS AND OTHER DISEASES. 



BY 



ALLAN McLANE HAMILTON, M.D., 

PHYSICIAN IN CHABGE OP THE NEW YOEK STATE HOSPITAL FOE DISEASES OF THE NERVOUS SYSTEM ', 

FELLOW OF THE NEW YOEK ACADEMY OF MEDICINE ; MEMBEE OF THE NEW YOEK 

NEUBOLOGICAL, AND COUNTY MEDICAL SOCIETIES, ETC. 



WITH NUMEROUS ILLUSTRATIONS. 







NEW YORK: 4 
D. APPLETON AND COMPANY, 

549 & 551 BROADWAY. 
1873. 



.Hz 



Entebed, according to Act of Congress, in the year 1873, 

By ALLAN McLANE HAMILTON, 

In the Office of the Librarian of Congress, at Washington. 



TO 

De. WILLIAM A. HAMMOND, 

PHY8ICIAN-EN-CHIEF OF THE NEW YOBK STATE HOSPITAL FOE DISEASES 
OF THE NEBVOTTS SYSTEM, ETC., ETC., 

THIS "WORK 

IS DEDICATED AS A PEOOF OF THE ATJTHOB's GEATITTJDE FOE THE 

MAjSTY KINDNESSES OF THE PAST. 



PREFACE. 



The need of a simple guide for the general practitioner 
has prompted the production of the following pages. I have 
endeavored to make them as practical as possible by avoiding 
as many of the confusing theories, technical terms, and un- 
proved statements, as I was able. In presenting this little book 
to the profession, I intend to indorse electricity only as a very 
valuable remedy in certain diseases, not as a specific for every 
human ill, mental and physical. As a therapeutical means in 
nearly all forms of Nervous disease, Electricity is invaluable. 

I have not mentioned several new modes of application, 
only because I think they have not been sufficiently or gen- 
erally tested. My book is the compilation of well-tried meas- 
ures and reported cases. 

I do not enter into the detailed description of the various 
diseases I allude to, as there are many elaborate and concise 
works upon this subject, that may be consulted by the reader. 

I am indebted to Drs. Frankel, Pifiard, Murray, Fisher, 
Eankin, and others, for their kindness in furnishing me with 
reports of cases and other data. 

ALLAN McLANE HAMILTON. 
110 East Thirtieth Street, April 10, 1873. 



CONTENTS 



ELECTRO-PHYSIGS. 
CHAPTER I. 

GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 

History of Electricity. — Frictional Electricity. — Conductors and Non-conductors. — 
Static and Current Electricity. — Electro-negative and Electro-positive. — Inten- 
sity and Quantity. — Ohm's Law. — Galvanometer. — Batteries, simple and com- 
pound. — Yoltaic Pile. — Smee's, Grove's, Grenet's, and Bunsen's Batteries. — 
Hammond's Battery. — Foreign Batteries. — Stohrer's Batteries. — Galvano-Fara- 
dic Company and Curt W. Meyer's Batteries. — Brenner Batteries. — Pulver- 
macher's Chains. — Garret's Disks, etc. — Rheotome, Rheostat, Current-Selector, 
etc., Page 11 

CHAPTER II. 

THE INDUCED CURRENT. 

General Laws of the Induced Current. — Theory of Induction. — Rotary and Chem- 
ico-Magnetic Batteries. — Induction Apparatus. — Galvano-Faradic Company's 
Apparatus. — Curt W. Meyer's Apparatus, . . . . . .26 

ELECTRO-PHYSIOLOGY. 
CHAPTER III. 

PHENOMENA OF THE TWO CURRENTS. 

Inherent Electricity of Animal Bodies. — Phenomenon in Nerve-Trunks and Muscles. 
— Action of Blood upon the Galvanic Needles. — Scoutellen's Theory. — Effects 
of Electricity upon special parts. — Different effects of the Two Currents. — Dif- 
ferent conditions varying the influence. — Action on the Nervous System. — The 
Brain, Spinal Cord, etc. — Tongue, Eye, Ear, etc. — Motor Nerves and Muscles. — 
Electrotonus. — Point of Indifference, etc. — Muscular Contractility and Sensibil- 
ity. — Upon the Sensor Nerves. — Upon the Sympathetic. — Upon the Blood. — 
Upon the Organs of Digestion and Secretion. — Upon the Urinary and Sexual 
Organs. — Upon the Absorbents. — Influence upon the Process of Nutrition. — 
Upon the Skin, 32 



8 CONTENTS. 

ELECTRO-THERAPEUTICS. 
CHAPTEE IV. 

GENEBAL CONSIDEEATION OF ELECTEO-THEBAPETTTICS. 

Nomenclature. — Difference between the Two Currents. — Their Characteristics. — Elec- 
trodes. — Sponge Electrodes. — Duchenne's Electrodes. — Metallic Electrodes. — 
Points de Duchenne. — Duchenne's Cup. — The Electric Scourge or Brousse. — 
Double Electrodes, Rheostat, .... , Page 43 

CHAPTER Y. 

GALVANIZATION. 

Effects of Galvanization of the Brain. — Of the Cord. — Galvanization of the Great 
Sympathetic (Central Galvanization). — Diplegic Contractions. — Galvanization 
of the Pneumogastric. — Of the Ear, Tongue, Eye, etc. — Galvanization of the 
Rectum. — Of the Urethra. — Galvanization of the Nerves and Muscles, . 49 

CHAPTER VI. 

FAEADIZATION. 

Duchenne's Observations, — Methods of Faradization. — Faradization of the Nerves 
and Muscles. — Electro-Anatomy. — Faradization of the Skin. — Of the Tongue, 
Ear, Eye, etc., etc. — Of the Rectum, Bladder, Larynx, and Pharynx. — Of the 
Uterus, etc., etc, . . 57 

CHAPTER VII. 

DIAGNOSIS BY ELECTEIOITY. 

Diagnosis by Electricity, etc., . . . . . . . . . .65 



SPECIAL ELECTRO-THERAPEUTICS. 
CHAPTER VIII. 

PAEALYSIS. 

The Use of the Currents. — Modification of the Currents in Special Paralyses, etc. — 
Cerebral Paralysis. — Diagnosis of Cerebral Paralysis. — Seguin's Thermometer. 
— JEsthesiometers. — Dynamometer. — Treatment. — Prognosis. — Spinal Paraly- 
sis. — Peripheral Paralysis. — Lead-Paralysis. — Hysterical Paralysis. — Infantile 
Paralysis. — Traumatic Paralysis. — Facial Paralysis. — Reflex Paralysis. — Paraly- 
sis of the Bladder. — Rheumatic' Paralysis. — Dysphonia and Aphonia. — Glosso- 
labio-pharyngeal Paralysis. — Progressive Locomotor Ataxy. — Progressive Mus- 
cular Atrophy, etc., etc., : *70 



CONTENTS. 9 

CHAPTER IX. 

H YPEK^ESTHESI A, ETC 

Neuralgia. — Its varieties. — Etiology. — Facial Neuralgia. — Cervico-brachial Neural- 
gia. — Intercostal Neuralgia. — Gastrodynia. — Tic-Musculaire. — Sciatica. — Rheu- 
matism. — Anesthesia. — AnEesthesia of the Sensory Organs. — Asphyxia, 
etc., Page 102 



CHAPTER X. 

CONVULSIVE DISEASES. 

Chorea. — Scrivener's Palsy. — Paralysis Agitans. — Epilepsy. — Tetanus. — Asthma. — 
Torticollis. — Diseases of Women. — Intra-Uterine Galvanic Pessary, etc. — Elec- 
tricity in Obstetrics. — Diseases of the Eye. — Constipation and Intestinal Ob- 
struction. — Skin-Diseases, 115 

CHAPTER XL 

ELECTEOLTSIS. 

Theory of Electrolysis. — Anions and Cations, etc. — Steps of Operation. — Needles 

and Apparatus. — Electrolysis of Aneurisms (Galvano-puncture). — Malignant, 

Erectile, and Serous Tumors. — Goitre. — Hydatids. — Hydrocele. — Stricture. — 

• Galvano-therapy of Wounds and Ulcers, Naevi, etc., .... 133 

CHAPTER XII. 

GALTANO-OAUSTT, ETC. 

Batteries, Electrodes, etc. — The Operation. — Cases. — Miscellaneous Uses of Elec- 
tricity. — Electric Baths. — Absorption of Inflammatory Products. — Spermator- 
rhoea. — Orthopraxy. — Vomiting of Pregnancy. — Detection of Metallic Sub- 
stances. — Carbuncles and Furuncles, etc., etc., 159 



APPENDIX. 

Management of Batteries. — Solutions for Batteries. — Insulation of Needles. — Gal- 
vauo-Causty Apparatus, etc., etc., 182 



ELEOTBO -PHYSIOS. 



CHAPTEK I. 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 

History of Electricity. — Frictional Electricity. — Conductors and Non-conductors. — 
Static and Current Electricity. — Electro-negative and Electro-positive. — Inten- 
sity and Quantity. — Ohm's Law. — Galvanometer. — Batteries, simple and com- 
pound. — Voltaic Pile. — Smee's, Grove's, Grenet's, and Bunsen's Batteries. — 
Hammond's Battery. — Foreign Batteries. — Stohrer's Batteries. — Galvano-Fara- 
dic Company and Curt W. Meyer's Batteries. — Brenner Batteries. — Pulverma- 
cher's Chains. — Garret's Disks, etc. — Rheotome, Rheostat, Current-Selector, etc. 

It is unnecessary to follow up the history of electricity ; suf- 
fice it to say that Thales, many centuries ago, demonstrated the 
first rudiments of this force, and, since his day, Galvani, Yolta, 
Ampere, Franklin, Faraday, and many others, have groped in 
the darkness and uncertainty of the subject, and have succes- 
sively brought new facts to light to astonish the world and ad- 
vance the knowledge of electric science. 

Thales, who lived six centuries before Christ, knew that, 
when amber was rubbed with silk, it acquired the property of 
attracting light bodies, but not till several hundred years after- 
ward was it known that other substances possessed a like 
quality ; and these were sulphur, wax, glass, etc. Dr. Gilbert, 
physician to Queen Elizabeth, was the demonstrator of these 
facts. In the year 1789 contact electricity was discovered by 
Galvani, and in the year 1831 induction electricity was given to 
the world by Faraday. 

When a glass rod or stick of sealing-wax is rubbed with a 
piece of flannel or fur, it will be found to have acquired the 
power to attract some very light body — for instance, a pith-ball, 



12 



CLINICAL ELECTRO-THERAPEUTICS. 



feather, gold-leaf, or piece of paper — which is repelled after- 
ward. All substances do not, however, receive this electric 
excitement ; some metals being occasional exceptions. When 
a body, electrified, is brought in contact with a new substance, 
that substance will or will not receive the electricity from the 
first substance — for instance, when one part of a glass rod is 
electrified by friction, the extremity of the rod not acted upon 
will not receive the electricity from the excited part imme- 
diately in contact. This property of receiving and conveying 
electricity we call conduction. Bodies are conductors, or, vice 
versa, non-conductors. But this division is not definite ; some 
bodies will only offer resistance to the passage of the current, 
and conduct poorly. We call this latter class 1 semiconductors. 



Connectors. 
Metals. 

Well-burnt charcoal. 
Graphite. 
Acids. 

Aqueous solutions. 
Water. 
Snow. 
Vegetables. 
Animals. 
Soluble salts, etc. 



Semi-con ductors. 
Alcohol and ether. 
Powdered glass. 
Flowers of sulphur. 
Dry wood. 
Paper. 
Ice at 0°. 



Non-conductors. 
Dry oxides. 
Ice at 25° C. 
Lime. 

Lycopodium. 
Caoutchouc. 
Air and dry gases. 
Dry paper 
Silk. 

Diamonds and precious stones. 
Class. 
Wax. 
Sulphur. 
Resins. 
Amber. 
Shellac. 



This list is arranged in the order of decreasing conductivity, 
or increasing resistance. Certain influences affect conductivity, 
i. e., heat, cold, and moisture; red-hot glass is a very good con- 
ductor, water when frozen is a bad one, etc. Poor conductors 
are sometimes called insulators, that is, they confine electricity 
to good conductors which they surround. 

It is impossible, without going into the subject very deeply, 
to give a minute description of the phenomena of electricity ; 
for this I refer you to any of the good text-books. 

In Electro-therapeutics we make use of two varieties of 
electricity : 

1 Ganot's " Physics," p. 565. 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 13 

1. Static or frictional electricity. 

2. Current electricity. 

This latter includes galvanism, and induced, or faradic elec- 
tricity. 

Static electricity is generated by friction, and, whether pro- 
duced by the cumbrous plate-machine of Holtz, or the simple 
glass tube and handkerchief, is the same. It has a certain pe- 
culiar characteristic, and that is, that it has the power of produ- 
cing a change in the air, converting the oxygen immediately into 
ozone. Static electricity is analogous to lightning in this re- 
spect, and the peculiar change in the atmosphere after a thun- 
der-storm is due to the production of ozone on a larger scale. 
Static electricity produces but feeble physiological changes. It 
is only when its tension is very great that any violent effects 
are shown, and then it may produce even death by the violence 
of its shock. It has little value in the field of electro-thera- 
peutics. Golding Bird has used it in chorea with success, and 
others have pronounced it efficacious in amenorrhcea and other 
female diseases. 

When applied to the skin, it produces a peculiar prickling 
sensation, accompanied by slight redness of the cuticle, and by 
hyperesthesia. It does not penetrate beyond the superficial 
muscles, and even the contractions it produces in them are very 
weak. 

The effects of static electricity may be condensed, however, 
by collecting it in a Leyden jar. The sensation communicated 
to a nerve or muscle is intense. A numbness in one end, and 
a violent contraction in the other, are experienced. Small ani- 
mals are easily killed by a moderate charge. The Leyden jar 
is clearly indicated when an irritant is wanted for the superfi- 
cial tissues ; it is not safe to use it, however, when deeper 
action is desired. 1 

CURRENT ELECTRICITY. 

This form of electricity is also known as dynamic, or con- 
tact, and is by far the most important variety. 

If two unlike conductors are brought together, either solids 
and fluids, or metals and gases or fluids, an electric current will 

1 Meyer's " Medical Electricity." 



14 CLINICAL ELECTRO-THERAPEUTICS. 

be generated. The current produced by gases is very weak, 
but when two metals, an electro-negative and electro-positive, 
are brought together in an exciting solution, the current is 
more powerful. The more remote from each other the bodies 
stand in the scale, the more active will be the production of the 
electric fluid. The following table gives the electro-negative 
and electro-positive elements in their proper order : 



+ 1 






Zinc. 


Iron. 


Platinum. 


Lead. 


Antimony. 


Carbon. 


Tin. 


Copper. 

Silver. 

Gold. 


2 



When two of these are placed in contact in acidulated water, 
the current in the connecting wire proceeds from the one lower 
in the scale to the one higher, the two extremes giving the 
most intense results. 

The electrical deportment of any metal depends, therefore, 
on the metal it is associated with. Iron, for instance, is electro- 
negative toward zinc ; copper is electro-negative toward zinc ; 
and iron but electro-positive toward silver. 

If the wires connecting the plates of the battery be cut, the 
terminal ends of each receive the name of poles.* The current 
passes from the — to the -t- under the surface of the solution, 
and vice versa above. When the extremities of the wire are 
brought together, the point is called the terminal arch. 

Polarization. — During the action of all batteries there is a 
process going on known as polarization, which presents the 
following phenomena : When the elements of the battery are 
immersed in the exciting solution, hydrogen and oxygen are 
formed by the decomposition of the water. The hydrogen 
goes to the copper pole at once, and the oxygen to the zinc. 
There is a local action going on all the time on the surface of 
the plates ; by this small currents are generated between the 
impurities in the zinc and the zinc itself. As this process con- 
tinues, the current loses its intensity, and is finally destroyed. 

1 + represents the electro-negative sign. 
8 — represents the electro-positive sign. 
3 " Electrode " is also used for the term pole, from qXetcrpov and oSog, way, 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 15 

Amalgamation of the zinc-element prevents this. Another 
phenomenon of polarization may be the accumulation of hy- 
drogen at the negative plate, and with this there will be a 
deposit of zinc, or positive metal, on the copper, or negative 
plate. In this way a current directly adverse to the original 
will be produced. This tendency may be overcome by simply 
breaking the current or wiping the plate. 

Quantity antd Ixtexsity are terms of great importance in 
the nomenclature of the electric current. Quantity signifies an 
inert volume of electricity ; while tension, or intensity, the en- 
ergy by which the cm-rent is impelled. The origin of this pro- 
pulsion is due to the number of cups and the strength of the 
exciting solution. For quantity a large plate-surface is re- 
quired, while for intensity a great number of small cells gen- 
erate a current of tension with no more quantity than the first 
cell furnishes. The tension increases with the number of 
plates ; in the middle the free electricity is inconsiderable, 
while the poles of the battery are the two opposing halves. 
The junction of the negative element of one cell to the posi- 
tive of the other prevents the formation of more than a certain 
amount of electricity, and the resistance it has the power to 
overcome in its circuit, in many cells, is just the power in one 
cell multiplied by the number. 

Ohm's law is unintelligible to the ordinary mind almost, on 
account of its obscurity ; but Smee, in his " Elements of Elec- 
tro-Metallurgy," * has condensed it as follows : 

" The action (A) is equal to the electro-motive force (E) 
multiplied by the number of cells (n), divided by the resist- 
ance the current has to overcome, external to the liquid of 
each battery (K), plus the resistance encountered by the pecul- 
iar arrangement of each cell (r) multiplied by the number of 
cells (n). 

It would be thus : 

nE 
A ~nK + r 

In this formula, Ohm has discarded the terms quantity and in- 
tensity, and unfortunately has adopted the contact instead of 
the chemical theory of the pile." 

1 " Elements of Electro-Metallurgy," p. 11. 



16 



CLINICAL ELECTRO-THERAPEUTICS. 



All the phenomena of tension may be studied with the gal- 
vanometer, and this consists of a needle balanced above a coil 
of insulated wire ; when this is connected with the battery, the 
deflection of the needle indicates the tension of the current. 

Galvanic batteries may be simple or compound. This dis- 




Fig. 1.— Simple Battery. 




Fig. 2.— Compound Battery. 

tinction consists in the fact that a simple battery has one cell 
(Fig. 1), while a compound battery has a number, the poles of 
the elements in each being joined alternately (Fig. 2), as I men- 
tioned when I spoke of tension. When the terminal ends of 
the wires connecting the poles are separated, the circuit is said 
to be broken. The combination of the various electro-negative 
and electro-positive metals and the variety of exciting solu- 
tions are almost numberless. From the simple voltaic pile, with 
which most of the earliest experiments were made, to the more 
complicated apparatus of the present day, the march of im- 
provement has been rapid. The voltaic pile is dismissed al- 
most entirely. Dr. Hammond, of this city, has made an im- 
provement, however, and presents to the profession a most 
complete and excellent instrument (Fig. 3). It consists of a 
number of perforated boxes of zinc and copper, between each 
of which is interposed a piece of felt or cloth moistened by an 
exciting solution. In Europe the voltaic pile is confined chiefly 
to the operation of electrolysis by Ciniselli and others. 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 17 

Undoubtedly the simplest form of cell is that of Smee. 
(Fig. 4.) 

Smee's lattery is formed of carbon or silver and unpolished 
zinc well amalgamated, and needs but one cell and one fluid to 
excite it. The silver plate is coated with platinum. The zinc 




Fig. 3.— Dr. Hammond's Voltaic Pile. 

and the silver plates are held together by clamps, and the inter- 
position of a bar of hard wood prevents the passages of the 
current from plate to plate. The exciting solution is water 
acidulated with one-seventh its bulk of oil of vitriol. 

Grove's lattery is most powerful ; but, as its action is attend- 
ed with the fumes of hyponitrous acid, it does not rank as high 
in the list of electro-therapeutical instruments as some others. 
The negative element is platinum, and the positive zinc. The 
platinum plate is enclosed in a porous cell filled with nitric 
2 



18 



CLINICAL ELECTRO-THERAPEUTICS. 



acid; the zinc surrounds it, immersed in a dilute solution of 
sulphuric acid. In the operations of galvanic surgery perhaps 
it has value. 




Bunsen's "battery is a slight modification of Grove's. In 
this the platinum plate is substituted by carbon, and a solution 
of bichromate of potash is used instead of nitric acid. 

Grenefs lattery, described in many foreign text-books, is 
constructed for the purpose of galvano-causty. The elements 
and solutions are the same as in the Bunsen. Curt W. Meyer, 
of this city, has recently invented an improvement on the Smee 
battery, which is superior to the original (Fig. 5). Platinized 
lead and a large element of zinc are used, the exciting solu- 
tion being the same. 

Hammond' 's Battery, 1 — Quite recently Dr. Hammond made 
a modification of Hill's cell. Each cell contains about half a 
gallon of fluid. A disk of sheet-copper is laid on the bottom 
of the cell ; an insulated wire connects with this, forming the 
positive pole, the copper being the negative plate. About six 
inches above this a zinc plate is suspended upon a hanger from 
the edge of the glass. This zinc has a large hole in the centre. 
A binding screw on the hanger forms the negative pole. The 
body of the fluid consists of a saturated solution of sulphate of 
zinc. Occasionally crystals of sulphate of copper are dropped 
through the aperture in the zinc to the bottom of the fluid. We 

1 New York Medical Journal, November, 1871, p. 486. 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 19 

thus have two distinct solutions, which are separate, the denser 
solution of sulphate of copper remaining below. The two 

Fig. 5. 




plates are constantly surrounded by different solutions. A 
sixty-cell battery of this kind has been in use at the New York 




Fig. 6.— Hammond's Permanent Battery. 



State Hospital for the Diseases of the Nervous System for 
nearly a year, and, beyond the occasional supply of a few crys- 



20 



CLINICAL ELECTRO-THERAPEUTICS. 



tals of sulphate of copper, no other trouble has been taken, and 
its action is now as intense as on the first day of erection. 

A film of paraffin e poured on the surface of the fluid in each 
cell prevents evaporation, and does not interfere with chemical 
action. The Galvano-Faradic Company manufacture this bat- 
tery, and also a " regulator," combining current-selector, po- 
larity-changers, rheotomes, and a galvanometer, upon the plan 
of Remak's instrument. 

There are many foreign batteries which are no better than 
those made in this country. These are Middledorp's, Remak's, 
Fromhold's, and others. Drs. Piffard and Sass, of this city, 
both use Smee's elements, which they find answer every pur- 
pose as well as those of European manufacture. The desidera- 
tum in galvanic batteries is — 

1. That chemical action and consequent waste of material 
should be slight. This is overcome by using certain weak solu- 
tions, and having an apparatus that can easily be made to re- 
move the elements from the solution after use. 

2. The batteries must neither have too great quantity nor 
too little tension. 

The Stohrer battery combines these requirements, and has 



Fig. 7. 




been made by different makers in this city, with improvements. 
Messrs. Tiemann and Drescher both make the Stohrer batterv, 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 



2U 



and the Galvano-Faradic Company have constructed many 
which are the best I have seen. I have one in my office which 
I cannot too highly recommend. 

The elements in the Stohrer battery are carbon and zinc ; 
these are arranged side by side in a glass vessel, with a solution 
of bichromate of potass, sulphuric acid, and water, as an excit- 
ing medium. (See Appendix.) From sixteen to thirty-two 
cells are placed in two parallel rows, two cells connecting on 
either side. Above and between the two rows runs a long, 
wooden track, and on this slides a " coupler," to which are affixed 
two binding posts, from which emerge the positive and negative 
wires. By sliding this coupler backward or forward, any num- 
ber of cells can be used, and this is indicated by correspond- 
ing numbers engraved on a strip of brass that runs the entire 
length of the battery. Fig. 8 represents the apparatus made 
by the Galvano-Faradic Company. Two handles (2.2.) lower 
the cells, so that, when out of use, the solution is not in contact 
with the plates. 

Curt W. Meyer has made a very beautiful instrument, which 
he calls the " Universal Platina Zinc Battery." As the name 
indicates, platina and zinc are the elements. The exciting so- 
lution is sulphuric acid (Fig. 9). 

Yaried devices on top select the current, or number of cups, 
and also interrupt the current. 

Numerous attachments are adjusted to these batteries. The 
battery of the Galvano-Faradic Company is supplied with a 
very ingenious current-changer, by which the polarity of the 
current can be instantly changed. We can get the descending 
or ascending currents in this manner. 

To most of the batteries is attached an interrupter, or rheo- 
tome, by which shocks may be made by breaking the current. 
This is in some done by a toothed wheel, or in others by a 
pendulum moved by clock-work. 

Mr. Curt W. Meyer has just perfected a battery which cer- 
tainly deserves great praise for its simplicity. A glance at the 
cut (Fig. 10), and reference to Mr. Meyer's description, will 
enable the reader to appreciate its advantages. The elements 
are carbon and zinc : 

" The construction of the single cell will be seen in A. 



22 



CLINICAL ELECTRO-THERAPEUTICS. 



At the bottom of a glass tube, of the dimensions of a test-tube, 
is a platinum wire melted into it, extending as well inside as 
outside. The tube is filled one-third of its height with prepared 




gas-carbon ; above this carbon a saturated solution of water and 
sal ammonia is poured up to two-thirds the height of the tube, 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 23 

by which means the porous jar, as required in a Leclanche bat- 
tery, becomes unnecessary. The upper part of the tube is 




coated on the inside to prevent the solution from adhering to 
the glass, and so as not to form crystals of sal ammonia, which, 



24 



CLINICAL ELECTRO-THERAPEUTICS. 



by capillary attraction, would further soak up the solution and 
cause these crystals to rise over the upper edge of the tube. 
The tube is closed loosely on the top by means of a rubber 
stopper in which a rod is fastened connecting the zinc, so as not 
to be moved up or down. 





" B. The current-selector (m) serves to connect any desired 
number of elements by means of the two cord-pins (a and 



GENERAL CONSIDERATION OF ELECTRIC PHENOMENA. 25 

h) ; but only one must remain connected at a time ; the second 
cord-pin only serves to act, when an alteration of the number 
of elements is required, in which case the connected pin re- 
mains connected until the desired new connection is completed 
by means of the disconnected cord. In this manner any de- 
sired connection or any alteration in the number of elements, 
as well as any desired current-fluctuations, can be produced 
without causing an entire interruption." 

The Galvano-Faradic Company have recently made a most 
excellent modification of the celebrated Brenner battery, by 
which the cumbersome table of the original battery is done 
away with, and a neat glass case substituted. These batteries 
are furnished with a most complete set of rheostats, galvanom- 
eter, current-selector, etc., in a very small space. 

Pulvermacher's chain consists of a number of alternate slips 
of copper and zinc wired together in the form of a chain. 
When these are immersed in dilute acetic acid, a mild current is 
generated. These chains have been worn about paralyzed 
limbs, and the action sometimes has been sufficient to vesicate 
the part. Numerous disks, " galvanic insoles," etc., have been 
lauded by different physicians. Garret's disks will be hereafter 
alluded to. 



CHAPTEE II. 



THE INDUCED CUREENT 



General Laws of the Induced Current. — Theory of Induction. — Rotary and Chem- 
ico-Magnetic Batteries. — Induction Apparatus. — Galvano-Faradic Company's 
Apparatus. — Curt W. Meyer's Apparatus. 

The second division of current electricity is the induced, or 
faradic current ; but, before we go further, it will be advisable 
to consider briefly the theory of induction. 

It was Faraday who discovered that, at the moment of open- 
ing and closing a galvanic circuit, a current was produced in 
another conductor placed near that of the battery, and that 
this current ran in the opposite direction to the primary one. 
This current is but instantaneous, however, and only renewed 
on the closure or opening of the circuit, to disappear again on 
the instant, and reappear as often as the connection is made or 
broken, for, during this interval, or during all the time that the 
first current flows, the new one does not exist. A current of 
this kind is called the induced, or secondary current, in opposi- 
tion to the inducing, or primary one. This current was called 
by Duchenne faradism, in honor of Faraday, its discoverer ; 
whence have come into use the terms faradic or faradaic, and 
faradization, a term suggested in analogy with galvanization. 

In the production of the current by the magneto-electric 
machine, a bar of soft iron is magnetized and demagnetized, 
and this induces in a parallel wire a vibratory or to-and-fro cur- 
rent, which is more magnetic than the inducing current. 

The currents produced by the rotatory machine are broken in 
the interval between the interruptions, and are barely appre- 
ciable on account of their brevity. 



THE INDUCED CURRENT. 



27 



The course of the current is an important consideration, and 
may be learned by holding the conductors, or electrodes, in the 
hands, when the most pain will be experienced where the cur- 
rent leaves the body — that is, in the hand grasping the nega- 
tive electrode. 

The rotary magnetic machine and chemico-magnetic instru- 
ment both produce the same kind of electricity. They both 
have their champions, but the faradic current is that in general 
use. The electro-magnetic instrument often needs two persons 
for its manipulation, while the faradic can be set in motion and 
stopped without trouble, and the electrodes can be manipulated 
by one person. The electro-magnetic current is not reliable, 
varying in strength at different times. The coil of the induc- 
tion apparatus must be small, and the wire thin and fine. As 
I have said before, the induction apparatus should have two cur- 
rents — a primary and secondary. ■ Duchenne calls them " cur- 
rents of the first and second order." The primary acts more 
particularly on the muscles, while the secondary influences the 
sentient nerves. 

Induction Apparatus. — An induction instrument must con- 
sist of a battery, a coil, a centre bundle of wire, or piece of soft 
iron, and contrivances to break the current. The instruments 
in most common use are of this variety. Many different kinds 
are made, most of them wretched affairs, fabricated chiefly for 
empirics and domestic use. The more brass that attracts the 
eye, the better. One inventor states in his circular that his 
instrument furnishes ten currents ! It is 
better that Faraday died when he did, Fl& - n - 

than to have lived to see his discovery so 
improved upon. 

Happily we are emerging from this 
dark age, and the instruments now of- 
fered for sale are constructed upon scien- 
tific principles. Many makers now turn 
out really better instruments than those 
of European make. The instruments 
made by the Galvano-Faradic Company, of this city, Messrs. 
Curt Meyer and Drescher, of ]S"ew York, and Hall, of Boston, 
are all excellent. I have used the induction apparatus of the 




28 



CLINICAL ELECTRO-THERAPEUTICS. 



first-named company for some time, and am convinced that 
there are none better made. 

Fig. 11 represents a very ingenious attachment made to the 
Galvano-Faradic Company's batteries. It consists of a fork 
which regulates the vibrations of the rheotome by which the 



\ ** * £ \ 






±tz 



»i \ eo . eft \ "% 
© .Co. . C* 



* I £ ^ & ^ » 

° 2. ^ £ • w 

"o . 1 S % \ il % 

\1 3s # .go* 




intervals may be almost imperceptible on account of their 
brevity, or, contrarywise, the shocks occur very slowly, the in- 
tervals being longer. 



THE INDUCED CURRENT. 29 

They are portable, efficient, and never get out of order. 
Probably every one is familiar with this apparatus. Fig. 12 
gives a view of it, with the case removed. 

I append the description which Mr. Bartlett has published : 

" Letter A represents the graduated kinged rod, to the 
lower end of which the zinc plate is attached. The hinge (b) 
enables the rod to be laid on horizontally when the battery is 
not required for action, thereby preventing the accidental im- 
mersion of the zinc plate in the battery fluid. The graduated 
points on the rod exhibit the depth to which the zinc, when the 
rod is lowered down, becomes immersed in the fluid, thus indi- 
cating the battery-power obtained. 

" The spring 1 presses against the head (c) of the rod 
when that is fully down in the cell, and thereby becomes im- 
paired if it is not free from acids and untarnished. 

" B exhibits the movable disk which plays against the plat- 
ina point (5) connecting it with the battery. After continued 
use, this portion of the disk becomes oxidized by the electric 
spark. When this happens, the action of the instrument will 
be irregular. The disk being movable, may be turned a very 
little around on its pivot, whereby a fresh surface of its periph- 
ery will be brought to play against the platina point. The 
action of the instrument will then be immediately restored. A 
considerable interval may elapse before this change is re- 
quired. 

" The adjusting screw to which the platina point is at- 
tached occasionally requires rearrangement. This can be ef- 
fected by loosening the set screw (d) ; then, turning carefully 
the end thumb-screw (e) ; when the desired point is obtained, 
tighten the set screw, and all will be retained in position. The 
correct adjustment of this screw is essential to the motion of 
the machine. 

" C, adjustable fork, appertaining to the rheotome. The 
free end embraces the hammer, or vibrating armature spring or 
lever (D), between its prongs, so as to control the vibrations. 
When the fork is depressed, the upper end of the hammer can 
vibrate freely. When it is raised, its prongs will, in proportion 
to the extent of its elevation, limit the space for the vibrations, 
and consequently their rapidity will be increased. Thus we 



30 



CLINICAL ELECTRO-THERAPEUTICS. 



are enabled to control at will the interval between each shock, 
a point of great significance in therapeutics. 

"2 is a set screw placed to work against the fork, and 
regulate its position laterally in reference to the hammer. 
When it leans too much on either side, it can be regulated by 
this screw. 

" The hammer may lean over, if its spring should happen 
to be strained, either toward the magnet or in the opposite di- 
rection. This can be instantly remedied by the thumb-screw (h), 
which, on removing the platform and machine from the box, 
will be found below the spring. Loosening this screw will 
withdraw the hammer from the magnet ; tightening will over- 
come its outward inclination, so that, in either case, it can be 
made to resume its perpendicular position. 

" E the combined current and polarity changer. 

"^represents PowelVs hydrostat, or capping, broken away 
to exhibit the interior of the cell, the zinc plate (a), and the 
carbon plates (6 6). Interposed between the hard-rubber plate 
(7) and the top of the cell is a soft packing. The capping can 
be pressed down the desired extent by means of the thumb- 
screws (3 3), thus preventing the spilling or splashing over of 
the liquid, impeding evaporation, maintaining the strength of 
the battery fluid, and affixing the cells steadily in their places." 



Fig. 13. 




THE INDUCED CURRENT. 31 

The apparatus of Mr. Curt W. Meyer, of New York, has 
many modifications ; probably the best one is represented in 
Fig. 13. The cell is Mr. Meyer's modification of Smee. In this 
battery the current is very " smooth," and may be made very 
powerful, as the coil is large. For those who desire foreign in- 
struments, Stohrer's induction apparatus is made by Messrs. 
Tiemann, of this city, or Du Bois-Reymond's, Siemens & Hal- 
ski's, Ladd's, and Graiffe's, may be imported, but are expensive, 
and no better than those of American make. For the manage- 
ment of either of these instruments, I refer you to the maker's 
directions which accompany them. 



ELEOTEO-PHTSIOLOGT. 



CHAPTEE III. 

PHENOMENA OF THE TWO CURRENTS. 

Inherent Electricity of Animal Bodies. — Phenomenon in Nerve-Trunks and Muscles. 
— Action of Blood upon the Galvanic Needles. — Scoutellen's Theory. — Effects 
of Electricity upon special parts. — Different effects of the Two Currents. — Dif- 
ferent conditions varying the influence. — Action on the Nervous System. — The 
Brain, Spinal Cord, etc. — Tongue, Eye, Ear, etc. — Motor Nerves and Muscles. — 
Electrotonus. — Point of Indifference, etc. — Muscular Contractility and Sensibil- 
ity. — Upon the Sensor Nerves. — Upon the Sympathetic. — Upon the Blood. — 
Upon the Organs of Digestion and Secretion. — Upon the Urinary and Sexual 
Organs. — Upon the Absorbents. — Influence upon the Process of Nutrition. — 
Upon the Skin. 

Before considering the especial effects of electricity as a 
therapeutical agent upon the human body, we will dwell for a 
moment upon the consideration of the existence of certain cur- 
rents which are inherent. 

It is hardly necessary to speak of those animals endowed by 
Nature with electric apparatus of attack and defence. The 
properties of the gymnotus, or electric eel, the torpedo, or ray, 
are known to all. Du Bois-Beymond discovered that an elec- 
tric current exists in the trunks of nerves, and also in muscles, 
not only in the active but passive states. This current does not 
pass across the line of the nerve, but takes a course from the 
centre to the periphery. In the muscles the same phenomena 
are observed, but the current is much stronger. Every muscle 
and nerve contains ultimate electric molecules, which are sup- 
posed to move in these tissues with great regularity. They are 
positive and negative. 

This current may be demonstrated most clearly in the frog, 



ELECTRO-PHYSIOLOGY. 33 

and M. Nobili 1 performed several interesting experiments with 
the frog's legs, proving that a current passed from the mnscle 
to the nerve from above downward. 

De la Rive, Ahrens, Radcliffe, and others, demonstrated the 
existence of this current in the living animal in a state of inac- 
tion by the galvanoscope ; they found also that this free electri- 
city existed in all parts of the body in a positive form, and that, 
when the circulation is excited, the amount of inherent elec- 
tricity is increased. Freshly-drawn blood (arterial), Shettle 
says, produces a deflection of the needle of the galvanometer 
when contact is made by electrodes. Experiments made by M. 
Scoutellen, of Paris, advance a curious and not improbable 
theory, viz., that the electric current is generated in the circu- 
latory system — the venous and arterial bloods being different 
elements (electric), and the walls of the vessels porous cells, 
that, like batteries, they produce a current. This he verifies 
by experiments upon horses. He says that there is an appre- 
ciable positive current detected by the galvanometer passing 
from the arterial to the venous blood. All parts of the body, 
of course, being supplied by the sanguineous fluid, are supplied 
also by electric stimulation. These electric molecules demon- 
strated by Du Bois-Reymond are constantly stimulated by the 
electric fluid, and the different functions of the body are per- 
formed. " The oxygen contained in the red blood-globules 
burns up the organic molecules with which it is in contact, and 
produces heat." The influence of electricity effects, during 
digestion, the selection of the nutritive molecules and their 
assimilation. In respiration, the phenomena are the same. 
" These facts perfectly agree with the electric phenomena of 
combustion. The carbon takes the negative electricity, and 
the surrounding air the positive, or rather the current is estab- 
lished between the carbon and the oxygen of the air. Now, 
the principal action of the red blood, by reason of the oxygen 
in it, is the producing of a true combustion in our tissues." 

EFFECTS OF ELECTRICITY UPON SPECIAL PARTS. 

The wide difference in the effects of the two currents upon 
the various organs makes it no easy matter to concisely de- 

1 " Annales de Chimie et de Phys.," 1828, vol. xxxviii., p. 225. 
3 



34 CLINICAL ELECTRO-THERAPEUTICS. 

scribe the effects of electricity upon the body as a whole. We 
will find, for instance, that the galvanic current does not affect 
the muscles exactly as the faradic does ; that the effects upon 
the skin are different ; that sensation is excited by one not in 
the same way that it is by the other. Many influences also gov- 
ern the effects of these currents : dryness or moisture, a broad 
surface of metal in the electrode, or a point, and so on. The 
action of electricity is dependent also upon the condition of the 
organ it is applied to, the effects being vastly different in one 
organ from what they are in another. 

The time of application is another point. For instance, a 
current of electricity applied for a short time will stimulate the 
nerves and excite the circulation ; if beyond a reasonable time, 
paralysis of the nerve will ensue, and ultimately destruction 
of the tissues beneath. 

THE ACTION OF ELECTRICITY UPON THE NERVOUS AND MUSCULAR 

SYSTEMS. 

Upon the Brain. — When the brain is subjected to electrical 
stimulus, the effect is barely appreciable. The galvanic cur- 
rent produces but slight results. Flashes of light and a me- 
tallic taste in the mouth are the evidences shown in those parts 
receiving their nervous supply from the brain. Continuously 
applied to the exterior of the cranium, it is supposed to produce 
dilatation of the vessels in the cerebral substance. K. Erb * 
has demonstrated that the skull does not offer any obstructions 
to the passage of the current, and Meyer verifies this. 2 

Galvanization of particular parts of the brain will excite 
contractions of the muscles. Irritation of the corpora quadri- 
gemina produces muscular contractions. Matteucci proved that 
stimulation of the crura cerebri is also followed by muscular 
contractions. From the fact that all the symptoms of vertigo, 
retinal flashes, etc., are produced, we have all reason to suppose 
that the brain is affected by the electrical current. 

Upon the Spinal Cord. — In the vivisected subject, when 
the current is passed through the cord, violent spasms of the 
body will follow. In the medulla oblongata the same effects 

1 " Deutsches Archiv.," 1867, vol. iii., p. 237. 

2 Meyer's " Medical Electricity," p. 78. 



ELECTRO-PHYSIOLOGY. 35 

are observed, and are shown in the organs supplied by nerves 
whose roots of origin are in this part. When external elec- 
trization is made by the faradic current, we have like effects, 
but not so marked. If the spinal cord be cut, and the end of 
one-half electrized, contractions occur in all the muscles sup- 
plied by motor nerves coming from the electrized part. At 
different points, if stimulation be made, all nerves emerging 
from these parts, and other nerves inosculating with them, 
will come under the electrical influence. During the time of 
application of the continuous current the sensibility of the cord 
is gone. It may be pricked or injured, without any evidence 
of disturbed sensation. 

Two portions of the cord notably affected are the cilio- 
spinal (between the seventh cervical and sixth dorsal vertebrae), 
and the lumbar region (at a point corresponding to the fourth 
lumbar vertebra). At these two points the sympathetic nerve 
is electrified by the current, producing a dilatation of the iris 
when the cilio-sjoinal portion is electrified, and a decided con- 
traction of the vas deferens, bladder, and lower part of the 
rectum, when the current is passed through the lumbar region. 

It is doubtful if the electro-magnetic or static currents pro- 
duce any marked effects upon the cord. M. Erb, however, 
thinks that the continuous current is transmitted through the 
bony covering of the spinal cord on account of the amount of 
water it contains, much more easily than through the skull. 

The most marked effects of electricity, however, are upon 
the special organs of sense, and some of the most brilliant suc- 
cesses in electro-therapeutics have been shown in these parts. 

The Eye. — If we place one plate of a galvanic element upon 
the forehead, and another over the infra-orbital nerve, a vivid 
perception of light is produced. Galvanization of that part of 
the sympathetic supplying the iris will result in dilatation of 
the pupil. Direct irritation will result in contraction of the 
same. The flash of light produced by the electric current will 
follow the excitation of any part of the fifth pair, and the ac- 
tion is reflex. This Purkinje demonstrated. Other observers, 
among them Huete, have proved that the sensation is strongest 
at the maculse lutea. The flash is very vivid if the two points 
of the electrode be placed upon the conjunctiva. 



36 CLINICAL ELECTRO-THERAPEUTICS. 

The Auditory Apparatus. — The organ of hearing presents 
the following phenomena when influenced by the electric cur- 
rents. The sense of hearing is excited, and all sounds are re- 
ceived more acutely. If the meatus be filled with water, the 
current is conducted to the muscles of the tympanum, and this 
tissue is put in a state of tension ; consequently sounds have a 
higher pitch. During this operation the sensorium responds by 
sounds, not only at the closing, but during the circuit. The 
tension of the current governs this heightened appreciation of 
sound. If it be increased, the tension and irritation of the au- 
ditory nerves will be painful. The effect will be stronger if the 
negative pole be applied to the ear (Althaus). 1 

For a concise description of the effects of the currents upon 
the auditory nerve, I refer you to the observations of Dr. Bren- 
ner, of St. Petersburg, quoted by Dr. Althaus in his work. 

The Organ of Smell. — An impression upon the olfactory 
nerve is not produced except by the continuous current, and 
this effect is followed by giddiness and a peculiar smell. Dur- 
ing and after the galvanic influence, it is impossible to sneeze, 
and an acid odor is perceived. It must not be confounded, 
however, with the smell of ozone, which attends the action of 
the static instrument. 

The Organ of Taste. — Galvanic currents produce upon the 
tongue twitchings of that organ, a metallic taste, and flashes of 
light. This experiment may be tried upon a small scale by 
placing a piece of zinc beneath the tongue and a piece of silver 
on top. 

On bringing them together, this peculiar sour taste will be 
perceived, which has been ascribed to the formation of nitric 
acid by the electro-catalytic union of the nitrogen and oxygen 
of the air. The induced current produces (when moderately 
applied) twitchings of the tongue. It is supposed that these 
phenomena are induced directly through the gustatory nerve, 
just as flashes of light or sounds result when the current is di- 
rected to the retina or auditory nerve. 

Upon the Motor Nerves and Muscles. — Electrization of a 
motor nerve results in a contraction of the muscle supplied by 

1 Two other phenomena are produced by the electrization of these parts, viz., 
an increase of the salivary secretion and a metallic taste in the mouth. 



ELECTRO-PHYSIOLOGY. 37 

the same, which occurs only at the closure of the circuit, and 
ceases when the current is broken. A more violent effect will 
be produced when the negative current is applied to the nerve, 
and the positive to the muscle, even with a less amount of gal- 
vanic power. 

Remak ' describes a condition of the nerve that follows the 
passage of a galvanic current of high tension through its length. 
This he calls galvano-tonic contraction. The muscle supplied 
by the nerve remains in a state of tonic contraction during the 
passage of the current. Tonic contractions were also pro- 
duced in antagonistic muscles when the current was sent 
through special nerve-trunks. Galvanization of the median 
nerve, for instance, caused tonic contractions in all the exten- 
sors of the wrist and fingers. The induced current, on the 
contrary, produced clonic contractions, as did the interrupted 
galvanic current. The contraction increases in tonicity with 
the continuance of the closure of the galvanic current ; but 
with this there is pain, oftentimes very intense. The irrita- 
bility of the nerve influences the production of the contraction, 
and, if the current is applied for a long time, the muscle will 
lose its irritability, and not respond to the stimulus. When a 
nerve is galvanized for some time, the muscle passes into a 
state of tetanic contraction, and remains so often when the cur- 
rent is opened. This has been called " tetanization" 

Dr. John G. Mason has demonstrated, by experiment, that, 
when one muscle is thrown into a state of tonic contraction, 
and another is influenced by clonic contractions, in the first 
the temperature of the muscle will be considerably higher 
than in the muscle constantly contracting. He selected a rab- 
bit for his experiment, and found that the temperature of the 
muscle in tonic contraction was two-tenths higher than the 
other. 

Eitter found that when the current was applied directly 
with the nerve, its excitability was diminished ; but, if an tra- 
verse current was used, 2 the sensibility or irritability was in- 
creased. From these deductions a peculiar nerve-state has 
been called : 

1 " Galvano-therapie der Nerven und Muskelkrankheiten." 
8 From the periphery to the centre. 



38 CLINICAL ELECTRO-THERAPEUTICS. 

Elecbrotonus. — Our knowledge of this state is based upon 
the fact that each nerve has ultimate electric molecules. In the 
non-electrified state, these molecules are in what Du Bois-Key- 
mond terms the peripolar state ; that is, they are "turned 
toward each other with equal extremities, so that two molecules 
form, as it were, only one, possessed of one positive zone and 
two negative poles." "When in the electrotonic state, unequal 
poles are turned toward each other, and this arrangement is 
called dipolar. This polar arrangement is explained still further 
by the theory of Pfliiger. 1 • A certain current passed through a 
part of a nerve divides this part into two physiological sections 
or zones, which are different, and pass into one another at a 
point where the condition of the nerve is unchanged, which is 
situated at an equal distance from either of the poles. This is 
called thepomt of indifference. One of these sections is placed 
in a condition of increased excitability (catelectrotonus) at the 
negative pole ; the other is called the anelectrotonus, and here 
excitability is diminished, and this is at the positive pole. The 
state of increased excitability is propagated from the negative 
pole to either side, and that of diminished excitability goes 
from the positive in the same manner. 

The current belonging to the nerve then runs with, or is 
opposed by the electric current, producing these phases of irri- 
tability. 

Muscles possess several properties when influenced by the 
electric current. One quality has been called electro-muscular 
contractility. The electro-muscular contractility is the suscep- 
tibility of the muscle to direct electric stimulation, and the sus- 
ceptibility to the indirect action (irritation) is called motricity. 
The other condition is known as electro-muscular sensibility, 
which consists of the susceptibility of sensation, accompanying 
muscular contraction due to electric stimulation. Kemak thinks 
that this sensibility belongs to the sheath of the muscle, though 
Eckhard is inclined to ascribe it to the nerves directly supply- 
ing the muscle. 

The demonstration of the two qualities — electro-muscular 
sensibility and electro-muscular contractility — is occasionally 
demonstrated in electro-physiology. Some muscles supplied 

1 " TJntersuchungen," etc., p. 95 ; quoted by Althaus, p. 208. 



ELECTKO-PHYSIOLOGY. 39 

by nerves with motor-fibres in the maximum, are consequently 
more easily made to contract than when the nerve supplying 
them contains a preponderance of sensor fibres. With one set 
of nerves we get increased electro-muscular sensibility, with 
another, electro-motor contractility with the same current, and 
vice versa. There are certain circumstances which modify the 
electric irritability of a muscle. Bruises, laceration, and press- 
ure, derangement of the nervous system, etc., etc., diminish it 
notably. 

Upon the Sensor Nerves. — If the electrodes be applied to 
the surface of the body, a sense of warmth will be felt at the 
part electrized ; and, if the current be strong, it will produce 
" prickling," and soon extreme pain. Of course the two forms 
of current electricity produce different impressions. With the 
induced, if the interruptions be made slowly, they produce but 
slight stimulation of sensation ; but, if they follow each other 
in quick succession, the intensity of the sensation will increase. 
The variety of electrode will also govern the effect. A moist 
sponge will occasion but a mild disturbance of the sentient 
nerves ; but, if a bundle of wires or a plate of metal be applied 
to the skin, the pain will be almost unbearable. The constant 
or galvanic current intensifies the sensation, with a peculiar 
" burning." 

The parts supplied most by sensor nerves are those most 
influenced, the trifacial being that most worthy of mention. 

Remak holds that, the nearer the nerve is to the brain, the 
greater will be the excitability. 

The application of the electric current for any considerable 
time will result in a great diminution of nervous sensibility ; 
the conductors must be moistened, however, and the current 
continued, to produce these effects. 

There is a noticeable difference in the sensations caused by 
both poles. That of the negative is most intense, and the only 
way this can be explained is in the consideration that the re- 
sistance of the current is at this pole. 

Action of the Electric Current upon the Sympathetic. — In 
the consideration of the effects of the electric current upon 
the spinal cord, I alluded briefly to the phenomena produced 
when the sympathetic was irritated at the cervical and lumbar 



40 CLINICAL ELECTRO-THERAPEUTICS. 

parts of the vertebral column. I will now deal with the effects 
of the galvanic current upon other portions of this nerve. 

The other varieties of electricity have but slight effect upon 
the sympathetic. Faradism and static electricity give poor re- 
sults, but galvanism has a direct influence. This current applied 
to the cervical portion is followed by dilatation, then constriction 
of the pupil. The pulsations of the heart are at the same time 
diminished in frequency, and the tension of the carotids and 
the other arteries is decreased. Althaus 1 speaks of a change 
in the direction of the carotids, the line of ascension becoming 
more diverging. There are also changes in the circulation pro- 
ceeding from the influence exerted on the vaso-motor nerves. 
The calibre of the arteries is increased. This is verified by ob- 
servations made by Dr. Geo. M. Beard, 3 who found, in galvani- 
zation of the sympathetic, that the arteries of the retina were 
at first increased in size, and then diminished, and the analogy 
is, that the vessels of the brain underwent the same phenom- 
ena. Dr. Beard's experiments were verified by Drs. D. B. St. 
J. Roosa and Loring. 

Galvanization of the sympathetic certainly results in many 
important changes in the organs concerned in digestion, assim- 
ilation, and secretion, and these must be ascribed to this very 
influence upon the vaso-motor nerves. 8 

THE EFFECTS OF ELECTRICITY UPON THE OTHER SYSTEMS. 

Upon the Heart and Circulatory System. — The heart can 
be brought under the effects of the electric current by appli- 
cation to the vagi and sympathetici, to the cardial branch 
taking its origin from the medulla, also by the depressor nerve 
from the superior laryngeal, and locally. 

While the irritation of the sympathetic nerve by the gal- 
vanic current results in an almost instantaneous decrease in 
the number of pulsations, galvanization of the vagi will give 

1 Althaus, "Medical Electricity.," p. 256. 

2 " Observations on the Physiological and Therapeutical Effects of Galvanization 
of the Sympathetic," p. 7. 

3 Dr. Haimel (Allg. Wiener Med. Zietung, 1850-52) arrives at the following 
conclusions from his experiments : 

The motions of respiration become much deeper, the renal secretion is increased, 
nutrition is improved, and the weight of the body increases. 



ELECTRO-PHYSIOLOGY. 41 

no results unless the current be strong, when respiration is 
immediately interfered with, and very seriously. The counte- 
nance becomes dusky, and appearances of asphyxia are pre- 
sented. 

Application of the induced current to a point over the right 
ventricle will cause immediate contractions of the heart. 

Action on the Blood. — When the two poles of the battery 
are passed into a cavity filled with blood, a series of interesting 
changes follows. At the positive pole we find an accumulation 
of oxygen, which forms an acid, rapidly coagulating the albu- 
men in its vicinity. At the negative pole a corresponding ac- 
cumulation of hydrogen, and the collection of a mass of fioccu- 
lent, curdy substance, called by Smee "artificial chondrin." 
At the positive pole the fibrin e and salts are collected, besides 
the blood-corpuscles, in a firm clot quite black in color. 

Action upon the Organs of Digestion and Secretion. — The 
stomach, intestines, and other abdominal organs, answer read- 
ily to electric stimulation, whether applied to the nerves sup- 
plying these organs, or to the organs themselves through their 
coverings. 

Peristaltic movement may be excited either by faradization 
of the abdomen, or over the different abdominal nervous plex- 
uses. 1 Galvanization of the splanchnic nerves is followed by 
peristaltic movements, while faradization of the same nerves 
causes a diminution of these movements. The gall-bladder, 
when stimulated, contracts violently, and forces out its con- 
tents. 

The salivary glands respond to the electrical stimulus by an 
increased secretion. 

ZFpon the Urinary and Sexual Organs. — The ureters, blad- 
der, and male generative organs of secretion, all respond to the 
application of the electrical current in different degrees of ac- 
tivity. The uterus contracts gradually but violently, particu- 
larly if the current be sent in a longitudinal direction, by 
placing the negative pole on the cervix uteri and the positive 
on the spine. 

Upon the Ahsorhents, and Nutrition. — Richardson and oth- 
ers have demonstrated the peculiar and rapid absorption of 

1 Le Gros and Onimus. 



42 CLINICAL ELECTRO-THERAPEUTICS. 

liquids, medicine, chemicals, etc., into the system, through the 
agency of the electric current. 

Yon Briins and Bur, of Yienna, first demonstrated the fact 
that if a solution of iodide of potassium was applied to any part 
of the body (particularly a part where the integument was thin) 
and an electrode applied at the moist place, and another at 
some remote locality, free iodine would appear under this last 
electrode. 

In the processes of nutrition, the activity of endosmosis 
and exosmosis is excited, and the different oxidations are influ- 
enced. The production of urea is greatly increased. 

ZPpon the Shin. — An observation of the effects of both cur- 
rents upon the integument may be most advantageously made 
when we come to apply them as therapeutical agents. The 
phenomena are mostly all due to changes in the vascular 
supply. 

When the faradic current is applied to the skin, there is a 
paleness at first, due to contraction of the coats of the vessels 
beneath ; this is followed by redness. If the skin be dry, these 
appearances are more marked ; but, if it be damp, the current 
will pass to deeper parts with greater facility. A strong gal- 
vanic current produces an aggravation of these conditions, and 
may result in destruction of the tissues in immediate contact 
with the electrode. The negative current has the power to 
diminish the blood-supply in a part, and finds its place in elec- 
tro-therapeutics as an agent for the dispersion of cyanotic spots 
and other abnormal collections of blood in the capillaries. 



ELEOTEO-THERAPEUTIOS. 



CHAPTER IV. 

GENEEAL CONSEDEEATION OF ELECTEO-THEEAPEUTICS. 

Nomenclature.— Difference between the Two Currents. — Their Characteristics. — Elec- 
trodes. — Sponge Electrodes. — Duchenne's Electrodes. — Metallic Electrodes. — 
Points de Duchenne. — Duchenne's Cup. — The Electric Scourge or Brousse. — 
Double Electrodes, Rheostat. 

In the selection of the current, much confusion has been 
occasioned by the number of terms used in the designation of 
the two currents. This can be averted by the selection of two, 
which are generally accepted. These are — 

1. The galvanic current. 

2. The faradic current. 

The galvanic has the following synonyms : primary, con- 
stant, continuous, direct, etc., etc. 

The faradic is known as the induced, interrupted, second- 
ary, indirect, electro-magnetic, etc. 

A galvanic current may be broken up into shocks by a 
rheotome, and then it is known as " the intermittent or inter- 
rupted galvcmio current." 

As I have before said, and as the preceding pages show, 
there is a vast difference between the actions of the two cur- 
rents. Grave mistakes undoubtedly occur through an injudi- 
cious use of either, from an improper length of application, or 
an excess of strength or intensity. Other conditions also in- 
fluence their administration, and these are : the state in which 
the patient is ; whether there is exalted sensibility requiring a 
mild current, or a condition where the current can be borne 



44 CLINICAL ELECTRO-THERAPEUTICS. 

with indifference. Then, again, the health of the patient, the 
existence of central lesions, sex, age, and other influences. 

Serions disorders may be produced by improper electriza- 
tion, such as cerebral congestion, eclampsia, neuralgia, etc. ; an 
inverse current often producing these dangers. 

On the other hand, its value is shown in cases of atrophic 
diseases, in asthenic conditions, and other like disorders. 

Great improvements have been made in instruments since 
the days of quackery, and we now have scientific apparatus, 
electrodes, batteries, and machines. It is our object to treat 
special parts — nerves, muscles, or other organs — with some defi- 
nite purpose, and we should avoid the examples of the charla- 
tans of other times, whose only ideas were derived from the 
use of two tin handles, or the indiscriminate "pawing" or 
aimless sponging of all parts of the body. 

Electricity may be used : 

To stimulate muscular power and prevent atrophy ; to pro- 
mote assimilation or secretion ; to excite peristaltic action, ab- 
sorption, and circulation ; to overcome depressed states of the 
system, whether from extreme exhaustion, narcotic poisoning, 
syncope, or suspended animation ; to correct deranged sensa- 
tion ; to relieve pain (neuralgic or otherwise) ; to act revulsive- 
ly on the nerve-centres in various central disorders, even in- 
cluding some chronic inflammations, congestions, etc. ; by its 
chemical action, to coagulate the blood, as in aneurisms and 
varices ; to alter and remove tumors and glandular swellings, 
and as a surgical agent in cauterization, etc. 

"We have briefly considered static electricity ; it is therefore 
hardly worth while to again refer to the subject ; suffice it to 
say, it has been used in chorea, hysteria, epilepsy, paralysis, 
nervous deafness, rheumatism, and amenorrhcea. Galvanism 
and faradism meet almost all indications, however, and should 
be given the preference. 

GALVANIZATION AND FARADIZATION. 

The relative difference between the two currents, and the 
advantages over each other, may be considered as follows, and 
the comparative table on the next page will show their respec- 
tive virtues : 



GENERAL CONSIDERATION OF ELECTRO-THERAPEUTICS. 



45 



The Galvanic Current 
Has a great power of overcoming re- 
sistance, hence it is adapted when 
deeper parts are to be influenced. 
It produces muscular contractions more 
violently, and even when the faradic 
fails to do so. 



The electrotonic and catalytic effects 
are marked. 

It is employed always as a catalytic. 

Its thermal effect is an important char- 
acteristic. 



ELECTRODES. 

The galvanic and faradic currents are 
applied to the various parts by instruments 
known as electrodes. These are almost in- 
numerable, and for every particular variety of 
electrization we have an electrode adapted to 
the part. Those in most common use, and 
by far the most important, are covered with 
sponge. The selection is large, and the shapes 
are many. I append cuts of those manufac- 
tured by instrument-makers in this city. Fig. 
14, made by Mr. Meyer, is applicable for all 
ordinary electrization of small muscles, but 
for large muscles, where the desire is to 
bring considerable surface under the in- 
fluence of the current, I am in the habit 
of using either A or B (Fig. 15), which 
are larger. Duchenne has invented two 
sponge-covered electrodes, which have the 
merit of . being compact and convenient 
(Fig. 16). 

For the electrization of other parts, we 
have smaller sponge-electrodes, either nar- 
row or pointed, for application to a nerve or 
small muscle, or they are elongated for intro- 



The Faradic Current 

Has but feeble power in overcoming re- 
sistance, and is used generally for stim- 
ulation of superficial parts. 

The rapidity of the interruptions which 
characterize this current enables it to 
produce muscular contractions more 
quickly than the galvanic. 

Its direct stimulating effects on the skin 
are more violent. 

Its electrotonic and catalytic effects are 
feeble. 

It is rarely employed as a catalytic. 

Its thermal effects are of very low order. 

Faradic currents do not produce the head- 
symptoms which are caused by the gal- 
vanic. 

Fig, 14. 




46 



CLINICAL ELECTRO-THERAPEUTICS. 



A 




duction into cavities or fossae. Some are made with swivel- 
backs, to be applied, for convenience, beneath the clothing. 

Again, other electrodes are not covered with sponge, but 
permit the bare metal to come in contact with the surface of 

the body. These may be pointed 
or flat, and the degree of irritation 
is increased by the amount of re- 
sistance made by the dry skin. 
These electrodes are particularly 
applicable when it is the desire of 
the physician to localize the cur- 
rent to a nerve, the skin, or to a 
special muscle. Ducheune has in- 
vented an excellent instrument, 
and it is named after him — the 
" points de Duchenne." Two 
points, such as depicted in Fig. 
17, are inserted into handles, and connected with the two poles 
of the battery. The pain is intense at the point of applica- 
tion, and when applied to dry skin, and a moderately strong 

galvanic current used, a lively elec- 
tric spark will dart from one to the 
other. 

"Duchenne's cups" Fig. 18) 
produce a peculiar counter - irrita- 
tion when applied to the dry skin, 
analogous to that produced by the 
" points," but more superficial. 

For muscular and cutaneous ex- 




Fig. 15.— One-fifth Actual Size. 





Fig. 16.— Manner of using Duchenne's 
Electrodes. 



Fig. 17.— Duchenne's Points. 



citation, we are provided with the "brousse electriquer This 
instrument, shown in Fig. 19, consists of a bundle of fine wires, 
or gilt cord, inserted into a handle. 



GENERAL CONSIDERATION OF ELECTRO-THERAPEUTICS. 47 

Numerous ingenious electrodes are made, in which the 
current may be interrupted by simple breakage of the circuit 
by means of a spring in the handle, and others have been 
devised where both terminal ends of the poles are passed 
through one handle. Dr. Piffard, a gentleman who has add- 
ed to electro-therapeutics many new and valuable inventions, 
first brought an instrument of this kind to the notice of the 





Fig. 18.— Dnchenne's Cups. 



Fig. 19. 



profession. Fig. 20 shows the construction of Dr. Piffard's 
double electrode. Through a handle of ebony, the two wires 
from the battery pass, each terminating in a copper rod, and 
these are capped by sponges. The rods are flexible, and may 
be bent to any degree. Fig. 21 represents an instrument de- 
vised by myself, and used for the past year at the New York 
State Hospital for Diseases of the Nervous System. Through 
a metallic body pass two rods well insulated, and terminating 
in sponge-covered ends. These diverge, and may be made to 
form any angle, and are then retained in position by two little 
binding screws. From the rods, furnished with thumb-screws, 
two battery-cords pass to the apparatus. 

These double electrodes are excellent when the object is to 
electrize a small muscle or organ. The hand unoccupied may 
be used for holding the patient. 

It is often desirable to regulate the intensity of the galvanic 
current, and for this purpose an instrument has been devised, 
known as the rheostat. By this arrangement, the resistance of 
the current can be exactly gauged. This is done by the pas- 



48 



CLINICAL ELECTRO-THEKAPEUTICS. 



sage of the current through a greater or less length of wire, so 
that with one element a weak current can be obtained by 
passing its galvanism through a great length of wire, or vice 
versa. 



Fig. 20. 



f 




Fig. 21.— The Author's Double Electrode. 



CHAPTEE V. 



GALVANIZATION 



Effects of Galvanization of the Brain. — Of the Cord. — Galvanization of the Great 
Sympathetic (Central Galvanization). — Diplegic Contractions. — Galvanization 
of the Pneumogastric. — Of the Ear, Tongue, Eye, etc. — Galvanization of the 
Rectum. — Of the Urethra. — Galvanization of the Nerves and Muscles. 

In the consideration of galvanization, we must bear in mind 
the rules of electrotonus, and the other phenomena of electro- 
physiology. We must also consider the effects in health and 
disease, and the different conditions related in a preceding 
chapter, influencing the application of the current. 

In the exhibition of galvanism, there are two points that it 
is well to dwell upon. 

If we desire to restore diminished sensibility, we use the 
extra-polar catelectronus ; * on the contrary, when we desire to 
subdue an excited or over-irritated state, we use the extra-polar 
anelectrotonus. 2 

A prolonged application to the surface is very apt to pro- 
duce disagreeable skin-effects; or, if deeper parts are acted 
upon, the nerve may be fairly paralyzed instead of stimulated ; 
judgment must be therefore used in employing this powerful 
agent. 

GALVANIZATION OF THE BRAIN. 

This may be performed in several different ways. These are : 

1. The application of one pole to the forehead, the other to 
the occiput. 

2. The application of one pole to each temple. 

3. The application of one pole to each mastoid process. 

1 Ascending current. 2 Descending current. 

4 



50 CLINICAL ELECTRO-THERAPEUTICS. 

In the galvanization of but one hemisphere, we place one 
pole on the eyebrow, and the other to the mastoid process of 
the same side. 

Althans recommends that, when the patient complains of 
frontal pain, fulness, etc., the positive pole should be placed 
there ; but when the sensations are reversed, the occiput being 
the painful point, the negative pole should be placed in front, 
and the positive pole on the occiput. It is never well to pass 
the current for more than three or five minutes at a time, at first. 

Flashes of light, which are felt when the current is trans- 
mitted, will demonstrate a sufficient force. We should never 
continue its application when there is vertigo. From ten to 
fifteen cells are all that will be necessary, though in some cases 
I have used even thirty cells of the large battery at the New 
York State Hospital for Diseases of the Nervous System. 1 This 
great tension, however, will sometimes produce alarming symp- 
toms — not only vertigo and pain, but even vomiting, convul- 
sions, and other violent symptoms. 

GALVANIZATION OF THE CORD. 

This may be performed by the application of one pole to 
each end of the spinal column. The positive pole should be 
placed at the point of disease, if possible. The current should 
be inverse if the lesion is in the upper part of the cord, but 
direct if below. We should not prolong the application of the 
current beyond ^.ve minutes. It is unnecessary to use more 
than thirty or forty cells. 

GALVANIZATION OF THE SYMPATHETIC. 

The views of Bemak, which at first were so greatly ridi- 
culed, and afterward so well accepted (as is the case with all 
great discoveries), give us the most concise knowledge in re- 
gard to the galvanization of this nerve. 

~^-Its^Eemarkable therapeutical effects are shown upon remote 
organs almost entirely. As I have before stated, the two im- 
portant points that answer to the galvanic stimulus most nota- 
bly are : 

1 HUl's sixty-cell battery. 



GALVANIZATION. 



51 



1. The cervical portion. 

2. The lumbar portion. 

For the accomplishment of the first form, the negative pole 
should be applied to the superior cervical ganglion in the auri- 
culo -maxillary fossa, below and behind the angle of the lower 



Fig. 




A. Auriculo-maxillary Fossa. 

B. Course of Phrenic Nerve. 

C. Manubrium Sterni. 



D. D, D. Sterno-cleido mastoid. 

E. Sup. Clavicular space. 

F. Clavicle. 



jaw, while the positive is placed above the manubrium sterni, to 
the internal side of the sterno-cleido-mastoid muscle, or to the 
seventh cervical vertebra (Fig. 22). By the latter application, 
we have the upper portion of the cord within the gal- 
vanic circuit ; by the former, the pneumogastric nerve. 
We may galvanize both sympathetics, if occasion re- 
quires. 

The seance should not last longer than two min- 
utes, and no more than twenty cells are to be used. 

Galvanization of the lower portion of the sympa- 
thetic can be performed, by applying the poles over the fourth 
lumbar vertebra. 

This current affords great benefit when there is a depressed 




52 



CLINICAL ELECTRO-THERAPEUTICS. 



condition of the nutritive processes, and in the treatment of 
anaemia, diseases involving the vaso-motor system of nerves, in 
cerebral hyperemia, and in progressive muscular atrophy. 

Eemak and Fieber have both witnessed phenomena that 
occurred when the continuous current was used on patients 



Fig. 24. 




2. Pneumogastric Nerve. 
4. Phrenic Nerve. 

25. Sup. Cervical Ganglion. 

26. Inf. Cervical Ganglion. 



OU. I 

81. ) 



Thoracic Ganglia of Great Sympathetic. 



suffering with progressive muscular atrophy. Certain contrac- 
tions, reflex in character, were observed, which they denomi- 
nated diplegia These occurred in muscles in the vicinity of 
ganglia. They are seen in the maxillary fossa the most dis- 



GALVANIZATION. 



53 



Fig. 25. 



Fig. 26. 



tinctly. These contractions are chronic in character, and occur 
also in cases of lead-paralysis. Althaus has observed them in 
hysteria as well. 

GALVANIZATION OF THE PNEUMOGASTRIC. 

What I have already said in my chapter upon electro-physi- 
ology will enable the reader to see why galvanism, when ap- 
plied to this nerve, is efficacious in trophic diseases. The 
anatomical situation of the nerve, and its distribution to the 
organs of digestion, account for this most fully. The negative 
electrode (a small sponge) should be placed at the angle of the 
lower jaw, on the carotid ; the positive pole is to be located 
over the point of origin of the sterno-cleido-mastoid. Althaus 
fixes the time of application at two minutes. 

GALVANIZATION OF THE ORGANS OF SENSE. 

For the electrization of the ear, we make use of the elec- 
trode depicted in Fig. 25. The patient is made to lie on his 
side, with his head in the 
same position, the affected 
ear upward. The electrode 
is then introduced, and the 
meatus filled with water; 
this electrode is then con- 
nected with the positive pole, 
and the negative pole (usu- 
ally sponge-covered) is placed 
immediately behind the ear. 

This is a most perfect way of bringing the force of 
the current to bear upon the paralyzed auditory 
nerve. It may be well to place the last electrode 
(the negative pole) over the opening of the Eusta- 
chian tube, or at an external point corresponding to 
the junction of the gustatory nerve with the chorda 
tympani. The seance should not last longer than 
three minutes. In galvanization of the tongue in 
cases of hemiplegia, the electrode shown in Fig. 
26 may be employed. Here the application may 
be continuous for several minutes. It is well to make appli- 
cation to the paralyzed muscles, to preserve their antagonism. 





54 CLINICAL ELECTRO-THERAPEUTICS. 

When the galvanic current is applied to the eye, we may 
have recourse to the convenient little instrument, Fig. 28. 



Fig. 27. 




A. Facial Nerve at its emergence from the stylo-mastoid foramen. 

B. Temporal branches. 

D. Supra-maxillary. 

E. Post-auricular branch of Facial. 

F. Supra-orbital. 

G. Infra-orbital. 



This should be filled with water and applied over the orbital 
cavity. It has undoubted efficacy when there is paralysis of 
the muscles concerned in the movements of the eye- 
ball ; also in ptosis and other affections. When sponge- 
electrodes are used, they may be applied to the angle 
of the jaw, and over the supra-orbital nerve. 

Galvanization of the rectum has been advised for 
muscular atony of that gut. The metallic electrodes, 
Figs. 29 and 30, insulated to within a few inches of 
their ends, are to be used, and a moistened sponge 
must be applied against the abdominal parietes. 

Galvanization of the urethra has been advocated 
by Mallez and Tripier, who have probably written 
more upon this subject than any other authors. I do not pro- 
pose to dwell upon their results, but will reserve these for an- 




GALVANIZATION. 



55 



other chapter. Galvanization of the ure- 
thra has been advised for spermator- 
rhoea, impotency, and stricture. In the 
treatment of spermatorrhoea, the current 
should be constant, but, in impotency, 



Fig. 81. 



Fig. 29. 



Fig. 30. 



£ 





intermittent. Special electrodes are used like 
those employed in some of the uterine operations 
(Fig. 31). 



GALVANIZATION OF TEDS NERVES AND MUSCLES. 

In the use of galvanism for the production of 
therapeutical effects in the nerves and muscles, it 
is well to include the spinal cord in the circuit. 
We may place one electrode over the lumbar, dor- 
sal, or cervical part of the cord, and the other to 
some muscle or nerve easily accessible. "When, 
however, the cord is not included, one pole may 
be placed on a superficial nerve or muscle, and the 
other to some peripheral part. The effect is most 
satisfactorily produced when the cord is included. 



56 CLINICAL ELECTRO-THERAPEUTICS. 

"When the paralysis is serious, the action then upon the central 
part (the point of nerve-origin) is excited much more vigorously 
than when a distant part is also subjected to a local stimulus. 
Of course, when the lesion is not central, but peripheral, the 
treatment must be directed to the involved part itself. When 
the vaso-motor nerves are the seat of disease, one pole should 
be placed upon the cervical ganglion, and the other to the 
affected parts. 



CHAPTEE VI. 



FARADIZATION. 



Duchenne's Observations. — Methods of Faradization. — Faradization of the Nerves 
and Muscles. — Electro- Anatomy. — Faradization of the Skin. — Of the Tongue, 
Ear, Eye, etc., etc. — Of the Rectum, Bladder, Larynx, and Pharynx. — Of the 
Uterus, etc., etc. 

It is to Duchenne that the credit belongs of having perfect- 
ed the local application of the currents (P electricite localise), 
and this mode of treatment is founded on the following obser- 
vations made by him : 

1. "When two dry electrodes (metallic cylinders connected 
with the instrument by pole-cords, and filled with sponge) are 
applied near one another, upon the thick, dry epidermis, the 
current does not penetrate the skin, but passes between them, 
crackling and sparkling. 

2. If one of the electrodes be moistened, a superficial sensa- 
tion is felt under the dry one. 

3. If the skin under both be slightly moistened, a stronger 
though still superficial sensation is perceived. 

4. If both sponges and skin are well wetted, there will be 
perceived neither sparks, crackling, nor burning, but instead, 
muscular contrations will be excited, accompanied by various 
forms of pain, according to the depth of the part acted upon. 

Duchenne makes use of two terms in the designation of two 
forms of application, and these are, the immediate and medi- 
ate electrization of muscles. The first is to be performed by 
applying the electrodes over the muscles, and the second by 
passing the current through the nerve-trunks. The terms 
immediate and mediate have as synonymes direct and in- 
direct The electrodes in both cases are to be held closely 



58 



CLINICAL ELECTRO-THERAPEUTICS. 



together, and every muscle, or collection of muscles, made to 
contract singly by the moist electrodes. The excitors should 
be placed on the belly of the muscle, if possible, but never on 
tendons. 

Drs. Kemak * and Ziemssen 2 went still further, and demon- 
strated anatomically and clinically the spots corresponding to 
the points of entrance of the motor nerves into the lateral bod- 
ies of the muscles. These gentlemen disagree with Duchenne, 



Fig. 32. 




and insist that the muscular contractions in every case occur 
through direct stimulation of the nerve. 

For the faradization of small muscles or nerves, the " points 
de Duchenne " may be used (Fig. 32). 

Muscular consciousness depends upon a difference in sensa- 
tion between different muscles. 

The bones are particularly sensitive to the faradic current, 
and the electrodes should not be allowed to rest on the subcu- 

1 "Uber methodische Electrisirung gelahmter Muskeln," Berlin, 1856. 
8 "Die Electricitat in der Medicin," Berlin, 185V. 



FARADIZATION. 



59 



taneous points of the body. This is accounted for by the fact 
that the current penetrates to the nerves of the periosteum. 

FARADIZATION OF THE MOTOR NERVES AND MUSCLES. 

The exact knowledge of the anatomical relations of the 
diseased part is of the most vital importance. In the arm the 
stimulus may be applied to the median nerve, on the inner and 
inferior third of the humerus, next to the brachial artery, and 
to the ulnar nerve, in the space between the olecranon process 
and the internal condyle. 



Fig. 33. 




A. Axillary Artery. B. Brachial Artery. C. Median Nerve. D. Ulnar Nerve. 

The radial nerve may be faradized at the junction of the 
two upper with the lower third of the humerus. The musculo- 
cutaneous may be reached in the axilla. As regards the lower 
extremities, we may faradize the crural nerve in the groin out- 
side of the femoral artery, and the sciatic either on its origin 
in the pelvis, through the posterior wall of the rectum, or near 
the tuberosity of the ischuim, behind the head of the femur. 

The obturator nerve may be reached near the obturator 
foramen, by placing the electrode vertically to the horizontal 
ramus of the pubis. The peroneal nerve is accessible at the 
posterior circumference of the head of the fibula, while the tibi- 
al may be faradized in the middle of the posterior surface of 
the knee-joint. 



60 



CLINICAL ELECTRO-THERAPEUTICS. 



The portio dura may be acted upon in the external meatus, 
by pressing a moistened conductor to the lower side of this 
canal. This proceeding is painful, and it is more advisable to 



Fig. 34. 



Fig. 35. 





A. Great Sciatic Nerve. 

C. External Popliteal Nerve. 

D. Post-Tibial Nerve. 



C. Internal Popliteal. 

D. External Popliteal. 



faradize the nerve after its emergence from the stylo-mastoid 
foramen, between the mastoid process and the condyloid pro- 



FARADIZATION. 61 

cess of the lower jaw. The larger branches of the pes anserinus 
may be faradized where they emerge from the parotid gland. 

In the supra-clavicular region the directors, placed on the 
clavicle, act on the brachial plexus. On top of the supra-cla- 
vicular triangle they are in connection with the external branch 
of the spinal-accessory nerve. The phrenic nerve is found on 
the anterior surface of the scalenus anticus. 

FARADIZATION OF THE SKIX. 

Duchenne has given to us three methods with which to per- 
form faradization upon the skin. These are — 

1. The electric hand. 

2. The electric brush, or whip. 

3. The metallic excitor. 

I have described the electrodes for the two latter methods 
in a previous chapter, and I will not refer to them, except it 
may be to say that the surface of the skin should always be 
dry. In callous or horny parts, such as the soles of the feet and 
palms of the hands, we may find it necessary to slightly dampen 
these places. The electric hand may simply be described as the 
hand of the operator, who grasps one of the sponges, and passes 
the unoccupied fingers over the surface ; the other pole is applied 
to a remote part. These methods are strongly recommended 
in cases of anaesthesia, neuralgia, and muscular rheumatism. 
The secondary current should be used ; that is, the current in- 
duced in the external coil that surrounds the magnet. The 
strength of the current should be regulated in parts where the 
sensibility is intense, and where the sensor nervous supply is 
great. The face is exquisitely sensitive. Where the skin is 
thin, we find this condition more marked. Faradization may 
be applied to the auditory meatus in the way alluded to in the 
discussion upon galvanization of the ear. 

For the application to the Schneiderian membrane, in cases 
of loss of sense, a moistened electrode should be put on the 
nape of the neck, and another passed over the whole of this 
membrane. 

Faradization of the rectum may be performed with the in- 
strument shown in Figs. 29 and 30. All substances should be 
removed therefrom first by an enema, however. 



62 CLINICAL ELECTRO-THERAPEUTICS. 

Duckenne's instrument for the application of this current 
(Fig. 36) in paralysis and atony of the bladder, consists of two 
wires insulated by a catheter, and terminating in two blades, 
which may be collapsed till the instrument presents the appear- 
ance of an ordinary catheter. It is better and more practica- 

Fig. 36. 





ble to introduce an ordinary metallic sound (well insulated) 
into the bladder, and apply a sponge-covered electrode over 
the symphysis pubis. Reliquet suggests that the bladder be 
filled with water by means of a catheter, and that the current 
should be passed through the column of water in the catheter. 
The application of electricity to the pharynx and larynx 
may be easily performed by the instrument depicted in Fig. 37. 
When we faradize the vocal cords, the laryngoscopic mirror 
must be brought into play. The other pole is connected with 



Fig. 37. 




a necklet worn about the patient's neck. It is not difficult to 
faradize the lateral adductor muscles of the vocal cords. The 
central adductor may be electrized by placing the conductor on 
the posterior surface of the arytenoid cartilages. External 
faradization of the larynx 1 in all cases is a simple procedure. 
The wire brush is used for this, while the remaining electrode 
is placed at the nape of the neck. Mild currents must be em- 
ployed. 

1 Faradization of the skin. 



FARADIZATION. 



63 



FARADIZATION OF THE UTERUS. 

This important branch of electro-therapeutics has received 
a great deal of attention of late, as it well deserves ; for it is 
impossible to help realizing its virtue in many diseases of this 
organ. 

The patient should lie on her back, and the operator, after 
introducing a speculum, is to put the uterine electrode (A, 
Fig. 38) in connection with the external os, after which an 




Fig. 38.— (After Althaus.) 



olive-shaped director (B) is introduced into the rectum, and a 
metallic plate, covered with moistened sponge, is placed over 
the os pubis. This latter communicates with B by means of a 
bifurcated conducting wire, with one of the poles of the appa- 



64 



CLINICAL ELECTRO-THERAPEUTICS. 



ratus, while the other pole is connected with the uterine elec- 
trode (A). In unmarried women, or when in the married the 
engorgement is not combined with displacement, the womb may- 
be faradized by simply using the plate over the os pubis, as be- 
fore, and a moistened conductor applied to the lumbar region. 
The application of the current should not exceed five minutes 
at a time (Althaus). Fig. 39 is a " cup-shaped " electrode for 
the uterus, which I consider superior to the electrode advised 



Fig. 39. 




by Althaus. Faradization of the mammse is advised by Pow- 
ell, when the secretion of milk has been stopped. 

I shall speak at length of faradization of the diaphragm in 
a .future consideration of electricity as a resuscitative agent in 
suspended animation. 



CHAPTEK YII. 

DIAGNOSIS BY ELECTRICITY. 

Diagnosis by Electricity, etc. 

For the diagnosis of paralysis and kindred diseases, we have 
an all-important agent in electricity, and, by the careful study 
of the observations of Dr. Marshall Hall, we can determine to 
a certainty the seat of disease. 

Dr. Hall divides paralysis into two kinds, spinal and cere- 
bral. " Spinal paralysis " 1 is not necessarily associated with a 
disease of the cord, but may exist in a muscle or group of mus- 
cles where connection with the cord has been severed, and are 
consequently without nervous supply. There may be a loss of 
voluntary power if the cord is diseased, or there may be simply 
paralysis of the muscle itself. Dr. Hall's term means, in fine, 
the functional separation of the muscle or muscles from the 
cord. Cerebral paralysis consists in the fact that connection 
between the muscle and brain is interrupted. There may be 
a lesion of the cord, but this does not have any direct connec- 
tion with the paralysis. 

A most important consideration in making a diagnosis by 
electricity is that of the qualities alluded to in a previous chap- 
ter, viz., electro-muscular contractility, and electric irritability. 
The following principles must also be observed in regard to the 
existence of these conditions : 

1. When a muscle is removed from the influence of the 
cord by destruction of its nerve, or destructive disease of the 
cord at the origin of the root, it loses its electric irritability very 

1 This term, as used by Dr. Hall, simply implies a functional paralysis ; Althaus 
substitutes the term " peripheral paralysis." 



66 CLINICAL ELECTRO-THERAPEUTICS. 

quickly. This condition varies in proportion to the amount 
of interference between cord and muscle. 

2. In brain-disease itself, there is a diminution or an increase 
in the contractility of the paralyzed muscle to the current. 

3. In spinal disease, when a part of the cord is divided, the 
electric irritability is diminished in the muscles which have 
their origin below the cut portion of the cord. If the nerves 
come from a healthy region, irritability is not influenced. 

4. Section of the nerves between the muscle and cord pro- 
duces the same results. Paralyzed muscles respond more slow- 
ly to the same amount of current (same tension) than do those 
that are healthy. This may be demonstrated by the simulta- 
neous application of currents of the same intensity to two limbs 
— the paralyzed one and that which is good. If ten cells will 
cause response in one, and not in the other, we may infer that 
the limb responding has a higher phase of electric irritability. 
In the London Lancet, April 16 and 23, 1870, pp. 539 and 575, 
Dr. Russell Reynolds says of this : " To test the true irritability 
of the muscle, you ascertain its readiness of response to a low 
power. If muscle A will act to a current of five cells, and a 
muscle B will act only to a current of ten cells, then muscle A 
is more irritable than muscle B. If the muscles of the right 
arm will act to a current of lower power than those of the left 
arm, then the muscles of the right arm are more irritable 
than those of the left. You must remember the difference of 
strength between the direct and the inverse current ; and, in 
testing the irrital >ility of the two arms respectively, be careful 
not to send the current up the one arm and down the other, 
and lose sight of that fact in your interpretation of the phe- 
nomenon. You often find, when applying a strong current of 
electricity to two limbs, one of which is paralyzed and the other 
healthy, that the muscles of the latter act much more vigor- 
ously than those of the former. You are not, however, to in- 
fer from such observation that the muscles so acting are more 
irritable. They are often less irritable than the others, but 
they are stronger, and when you put them into action they act 
more vigorously. In the one case you are testing irritability ; 
in the other you are testing power. To ascertain, then, the 
irritability of a muscle, i. e., to see how irritable it is, you must 



DIAGNOSIS BY ELECTRICITY. 67 

reduce the strength of the current you employ, whether faradic 
or galvanic, to the lowest point that will produce contraction. 
'With a more powerful current, all that you will show is that 
one muscle is stronger than the other ; for you lose sight of 
the finer differences of irritability in the obvious presence of 
the coarser differences of strength. If we take four or five 
cells of a galvanic battery, and apply the current, made and 
broken slowly, to a paralyzed muscle, we often find that it will 
respond much more readily than will a healthy muccle, because 
it is more ' irritable.' But, if we take thirty or forty cells, or a 
faradization-machine, we often find that the same healthy mus- 
cle will perhaps draw the hand out of the water, while the 
other (the paralyzed muscle) will merely give a little jerk. 
The healthy muscle in this case, though less irritable, is more 
strong." 

Electricity may be used as a test for imaginary or feigned 
disorders. If we find, after careful application of the current, 
that there is a difference in the muscles on either side, as in 
hemiplegia, we are justified in believing that the patient is not 
shamming. In a suspected case, when a strong current is ap- 
plied, it is impossible to resist the electro-muscular contractions 
of healthy muscles. Going further, we may base our diagnosis 
upon these rules. 

If the electric contractility of a paralyzed muscle is mani- 
fested, we may infer that its relationship to the cord is good, 
and that there is no intermediate severance of connection. 
There may exist brain-disease, interfering with the will, but 
the relationship between that portion of the cord furnishing 
nervous supply and the muscle is perfect. 

If contractility is increased, we may infer the same thing, 
but also that there is increased irritability of the brain or cord, 
probably due to increased vascularity of these organs. 

This state subsides in a few days in the patient, when slight 
contractility may reappear, and, after a little longer, when hy- 
peremia occurs, the contractility will be vastly increased. For 
this explanation, I take a case of cerebral haemorrhage. "With 
the excess of irritability, there will be either clonic or tonic con- 
tractions, and we should not endeavor to make further efforts 
at diagnosis, for it will be at great risk to the patient. 



68 CLINICAL ELECTRO-THERAPEUTICS. 

Hemorrhage, sclerosis, and myelitis, or the pressure of a tu- 
mor, may give a phase of excessive irritability. The lesion, if 
it be in the upper part of the cord, may result in a loss of elec- 
tric contractility in tlie muscles above, but an excess of irrita- 
bility in the muscles lower down. With this state there will 
be a condition of reflex irritability, e. g., tickling the soles of 
the feet will incite spasmodic movements. 

In those cases where contractility is diminished, we find 
that there is disease of the brain, which eventually ends in pa- 
ralysis and consequent loss of contractility. There may also 
be disease of the cord or the nerve. The impregnation of the 
blood with some poisonous substance, whether narcotic medi- 
cines or some of the metals, will produce a state characterized 
by diminution in muscular irritability. 

After cerebral haemorrhage, when a tumor or softening ex- 
ists, there will be reduced irritability of the muscle, due to 
wasting of the nerve, and atrophy. Electricity in these cases 
improves nutrition, and the depressed tone is heightened, but 
the central cause remains, and, when treatment is suspended, 
there is a relapse. 

When there is no response to the current, we may be sure 
the disease has invaded the cord. 

With true spinal paralysis (actual disease of the cord), we 
shall find the same phenomena, with loss of irritability and con- 
tractility in the muscle. General treatment and galvanism will 
remove the cause in time, by reflex irritation of the central 
parts, through stimulation of the peripheral end of the nerves. 

In certain conditions, such as facial paralysis, we have illus- 
trations of that form of paralysis when the nerve is divided or 
interfered with between the centres of supply and the muscle 
or muscles. In these very cases there is a diminution or loss 
of electric contractility in proportion to the damage done. 
This loss of contractility may occur within from a few hours 
to several days after a sudden lesion ; it may come gradually 
when the interruption of voluntary power is tardy. Electricity 
will not restore contractility when communication is effectually 
destroyed, but it will restore muscles that are atrophied. The 
application of the current, and the failure of good results, will 
tell us that the case is incurable, and exactly how much of the 



DIAGNOSIS OF ELECTKICITY. 69 

paralysis is due to disease and how much to want of muscular 
use. 

There is a loss of electric contractility sometimes which 
follows paralysis of the muscle itself, whether produced by a 
blood-poison, exposures, sudden blasts of wind {coup de vent), 
or other local causes. Here the paralysis is confined to certain 
muscles or groups of muscles, and bears no relation to special 
trunks. The deltoid, the muscles of one leg or arm, the facial 
muscles, may be paralyzed. "We can here employ the electric 
current to differentiate these local paralyses from those of the 
central form. Different conditions may exist in one region ; 
for instance, the hand will be hypersesthetic, and the deltoid 
devoid of contractility, or vice versa. "When this paralysis oc- 
curs in a muscle on account of malnutrition, the paralysis will 
be irregular, and the electric irritability not always present. 
One peculiarity in the electric diagnosis of this disease is, that 
electric irritability will not respond to a quickly-intermitted 
current ; by the faradic not at all. Galvanism uninterrupted 
produces no contractions ; but, if the current be slowly inter- 
rupted, it will meet with a response. 1 In cases of lead-poison- 
ing, facial paralysis from cold, etc., these observations are well 
verified. When muscular irritability is diminished by faradi- 
zation and galvanization, the disease will be difficult to cure. 

Several of the German writers have advised electricity as a 
means of detecting death in doubtful cases. Muscular contrac- 
tions will indicate that life is not extinct. 

1 This is explained by the fact that slow interruptions diminish the over-sensitive- 
ness of the muscle. When contractility gradually returns, faradism, and finally in- 
terrupted galvanism may be used. 



SPECIAL ELEOTKO-THEJRAPETTTICS. 



CHAPTEK YIII. 



PARALYSIS. 



The Use of the Currents. — Modification of the Currents in Special Paralyses, etc. — 
Cerebral Paralysis. — Diagnosis of Cerebral Paralysis. — Seguins Thermometer. 
— iEsthesiometers. — Dynamometer. — Treatment. — Prognosis. — Spinal Paraly- 
sis. — Peripheral Paralysis. — Lead-Paralysis. — Hysterical Paralysis. — Infantile 
Paralysis. — Traumatic Paralysis. — Facial Paralysis. — Reflex Paralysis. — Paraly- 
sis of the Bladder. — Rheumatic Paralysis. — Dysphonia and Aphonia. — Glosso- 
labio-pharyngeal Paralysis. — Progressive Locomotor Ataxy. — Progressive Mus- 
cular Atrophy, etc., etc. 

Electricity meets its most important indication in this 
class of disease. Its curative action has been so efficient, com- 
plete, and satisfactory, that cases which were formerly given 
up as hopeless are now very often greatly relieved, if not per- 
manently cured. After reading the last chapter, we can pretty 
nearly discriminate those cases capable of being benefited, and 
we are enabled to understand how to direct our treatment. In 
fact, it is absolutely necessary to make our diagnosis before do- 
ing any thing at all. After having settled upon a diagnosis, 
we are to observe the following rule : It is absolutely injurious 
to use the currents when the central lesion exists, consequently 
we would not think of employing it in recent cerebral haemor- 
rhage, or paralysis resulting from some acute inflammatory 
condition. These cases are recognized by the greatly-increased 
electric irritability, and the rigidity of the muscular contractions. 

The principles of electrotonus must be borne in mind. A 
descending current will be accompanied by a diminution of 
nervous irritability at the positive pole, and an increase at and 



PARALYSIS. 71 

above the negative. These results will be the same, but re- 
versed if the current be changed and made ascending or inverse, 
and below the irritability will be diminished, while above the 
current will be increased. These phenomena are exaggerated 
if the current be reversed (the polarity changed). "With these 
sudden interruptions or reverses of the current, there will be 
greater central effect, the intervals taking the character of 
shocks, oftentimes very severe. It is unwise to use the inverse 
current near the head, as the causation of central irritation is 
almost inevitable. 

Faradization should be employed in those cases where there 
is an impaired state of electro-muscular contractility. If a cere- 
bral or spinal lesion exists in an acute form, it will do but little 
good. It is therefore indicated more as a secondary means, to 
prevent atrophy, to stimulate the vessels of the paralyzed mus- 
cles, and the small nervous branches in their substance. In 
cases of local paralysis, whether from injury of the nerve or 
not, we can employ it with the hope of good results. In all 
cases where there is an existing cause, we must remove that cause 
before we can expect success. We must also closely examine 
the paralyzed limbs, for the paralysis is not always general ; 
there may be motility in some muscles and not in others, con- 
sequently it would be unwise to faradize both the sound and 
paralyzed parts. In certain wasting diseases dependent upon 
atrophy of the muscles, such as progressive muscular atrophy, 
when the muscles respond to the electric stimulus, we have the 
most gratifying results. Dr. C. Hilton Fagge, assistant physi- 
cian to Guy's Hospital, reports several cases in the Practi- 
tioner, which certainly show the most brilliant results attend- 
ing a proper use of this remedy. 

Electro-puncture was advanced by Remak as a means for 
producing the effects of the electric currents in the deeper 
paralyzed muscles. It has had efficacy, but I do not advise 
this most painful practice, which entails a vast amount of un- 
necessary suffering. 

CEREBRAL PARALYSIS. 

The occurrence of the effusion is usually followed by a pe- 
riod of some weeks, when the use of electricity would not only 



72 CLINICAL ELECTRO-THERAPEUTICS. 

be dangerous, but perhaps fatal. At this time an inverse cur- 
rent would increase the irritability, and perhaps produce a 
fresh apoplectic attaek. When we have convinced ourselves 
that the irritability at the point of effusion has subsided, we 
may begin treatment. In doing this, we are to gauge the elec- 
tric irritability of the muscles (their contractility), and are to 
take into consideration the state of the patient, his age, and 
other influences. If the lesion has been produced by embolism, 
softening, or disease of the brain-substance, we must also be 
guarded in the exhibition of our treatment. We must wait for 
absorption to he well under way. A proper use of the direct 
current must be made to hasten this, and a mild faradic current 
locally to prevent the atrophy of muscular tissue till the cere- 
bral mischief is over. 

It is well to observe a proper medium in the time of appli- 
cation, for, if we begin too early, the bad results I have just 
alluded to will follow ; if too long after the haemorrhage, we 
shall find that the response to stimulation will be weak. In 
muscles long paralyzed, the electric contractility will not re- 
spond to the faradic current, but a rigid and sometimes violent 
contraction will follow the galvanic. Daily seances should be 
made. The faradic current may be used in the following ways : 

1. One pole to some central locality, i. e., the lower part of 
the vertebral column, and the other to some peripheral point. 

2. One pole at one end of a muscle, and the other at its 
point of insertion. 

FlG 40 3. Mediate electrization (vide p. 57). 

4. Immediate electrization. 
A galvanic current of moderate ten- 
sion may be directed through the head. 
This treatment, with an auxiliary use of 
strychnia, iron, and phosphorus, will im- 
prove most cases of hemiplegia. Dur- 
ing our treatment, we should test, from 
week to week, the cutaneous sensibility. 
This may be done by an ingenious little 
instrument known as the aesthesiometer. 
Fig. 40 represents that form known as Hammond's aesthe- 
siometer. The approximation of the two points will indicate 




PARALYSIS. 



n 



the extent of morbid sensibility. When these points are 
brought together, the patient will distinguish both of them 
simultaneously at a certain distance of separation between the 
points. The minimum normal distances at which the two points 
can be distinguished in different regions of the body are as fol- 
lows : ' 



Fig. 41. 



t 



- 



Point of the tongue {a line. 

Red surface of lips 2 lines. 

Dorsal surface of third finger 3 " 

Metacarpal bone of thumb 4 " 

Palmofhand 5 " 

Mucous membrane of hard palate 6 " 

Dorsal surface of the first finger 7 " 

Mucous membrane of gums 9 " 

Lower part of forehead 10 " 

Lower part of occiput 12 " 

Back of hand 14 " 

Neck under the lower jaw 15 " 

Skin over the patella 16 " 

Skin over the sacrum 18 " 

Skin over the sternum 20 " 

Skin over the lumbar region 24 " 

Middle of the arm. 30 " 

Middle of the thigh 30 " 



In disease, the distances will be greater or less, 
according to the hyperesthesia or anaesthesia. 

The thermometer should also be used. Dr. Se- 
guin's improved thermometers, with broad bases, 
are excellent instruments, and with two of them 
placed simultaneously on the skin, we can compare 
the difference in temperature in two parts of the 
body — the paralyzed and the non-paralyzed. 

The muscular power should be tested also, and 
this may be done by the dynamometer. This instrument must 
be grasped in the hand, and one slow and forcible attempt at 
squeezing the two flat borders of the ellipse should be made ; 
the ends a and o will be expanded, and the transverse diameter 
diminished. "With this movement a toothed arm revolves an 
indicator, which registers the extent of the compression. The 
relative scale indicates the muscular power of the hand. This 

1 " Diseases of the Nervous System,'' Hammond, p. xvii. 



^S^B^bI 



Dr. Seguin's Surface 
Thermometer. 



74 



CLINICAL ELECTRO-THERAPEUTICS. 



instrument is ingeniously constructed to register the force ex- 
erted after the effort is made. It was invented by M. Mathieu 
of Paris, and first introduced into this country by Dr. ¥m. A. 
Hammond. 



Fig. 42. 




CASES. 

The prognosis of cases treated in the manner I have de- 
scribed, is exceedingly favorable ; in fact, it is impossible to 
thoroughly and quickly restore a paralyzed limb without elec- 
tricity. The existence of softening makes the prognosis inva- 
riably bad, the relief afforded being only temporary. If the 
patient's condition be such that there is a gradual breaking 
down, I doubt if electricity or any other mode of treatment 
will do any good. When the paralysis is so complete as to in- 
volve the sphincter ani and the muscular fibres of the bladder, 
improvement is unappreciable. 1 

I. Right Hemiplegia, the Result of Thrombosis, with Ataxic 
Aphasia. — "W. W., aged thirty-one. In March, 1868, first no- 
ticed the symptoms of formication ; numbness and feelings of 

1 Dr. Emil Fliess, of Berlin, relates the results of the treatment of eighty-five 
cases of hemiplegia with the constant current. The patients were of all ages, and 
the disease was of most various origin in different cases. Two methods were em- 
ployed : 1. Galvanization of the sympathetic, by placing one pole on the cervical 
sympathetic of each side, or else one pole on one sympathetic and the other on the 
spine or on the course of a cerebro-spinal nerve or on some indifferent spot. 2. Cen- 
tral galvanization ; a current being passed either from front to back of the brain, or 
along the spinal cord or centripetal, two points of a nerve-trunk being included in 
the circuit. Of sixty -four cases treated by the first plan, five were cured, and nine 
were much improved ; of fifty patients treated by the second method, two were 
cured, and seven much improved. Seven patients were also cured by the combined 
use of both methods. Only a slight improvement, or none at all, was noted in the 
rest of the cases ; in one, the treatment did harm. — {Quoted by Beard and Rockwell, 
p. 395.) 



PARALYSIS. 75 

heat and cold in the right side. In two weeks these symptoms 
advanced till they reached the shoulder ; there was no loss of 
consciousness. On the 11th of May, the patient lost the power 
of speech, and did not regain it at all till four months after- 
ward, when he was able to enunciate, in a very indistinct man- 
ner, a few words. 

The patient was admitted to the out-door department of the 
New York State Hospital for Diseases of the Nervous System, 
August 22, 1870, and came under the observation of Dr. T. M. 
B. Cross, who afterward treated him. His condition was this : 
" There was hemiplegia of the right side of the body, includ- 
ing the arm and the leg, but the face was unaffected. There 
was no strabismus nor facial paralysis. The pupils were very 
much contracted. The tongue did not deviate to either side. 
Every sense was unimpaired, except tactile sensibility. His 
intellect was as clear as ever ; no loss of the memory of words, 
no impairment of the motor power of the tongue, but simply 
a defect in the faculty of coordination of the muscles used 
in the act of speaking. The patient found more difficulty in 
pronouncing labials and Unguals than gutturals. There was 
much atrophy of the muscles of the right side of the body, but 
the process of degeneration was more advanced in the arm. 
Muscular power in the arm appeared to be nearly abolished. 
He could not bend the arm on the forearm, nor raise the arm 
by means of the deltoid. The dynamometer indicated but 
very feeble power of the right hand. Tactile sensibility, elec- 
tro-muscular sensibility, and contractility, together with tem- 
perature, were markedly diminished in the right arm, while 
sensibility to pain was normal. 

" Patient had but little power in the thigh, could hardly walk, 
and when he did so it was with a shuffling gait. Heart-sounds 
natural ; urine normal. The thermometer detected difference 
in temperature. The patient could not whistle, and in talking 
he had a peculiar hesitating, stammering manner. 

" The treatment consisted in the administration of hypoder- 
mic injections of strychnia, and the faradic and galvanic cur- 
rents. The former was applied three times a week to the leg 
and arm, and to the tongue and lips ; the latter to the head, as 



76 CLINICAL ELECTRO-THERAPEUTICS. 

has been directed by Dr. Hammond. With this treatment, 
small doses of phosphorus were given. 

"November 15th. — The case has shown the most marked 
improvement. The patient can articulate words containing 
many labials and dentals. The muscles of the right upper ex- 
tremity have increased in strength ; he can flex his forearm on 
the arm, raise the arm at a right angle to the body above his 
head, and keep it there voluntarily. He walks with greater 
ease, and lifts the toe off the ground. All the muscles respond 
to the weak faradic current. Sensibility is gradually return- 
ing, while the temperature and nutrition of the limbs are con- 
stantly increasing. The patient has so far recovered that he 
intends to make an attempt to earn his livelihood by engag- 
ing in some light business which only requires moderate ac- 
tivity." 

II. Right Hemiplegia — Cure. — O. S., aged fifty-two, butler, 
came under my charge October 2, 1872. He had been deprived 
of consciousness and power of motion a year before, by a cere- 
bral haemorrhage, and, after resuming the duties of his avoca- 
tion some months afterward, continued well till three months 
ago, when a second attack prostrated him ; but, through the 
good treatment he received at Bellevue Hospital, he partially 
recovered the power of locomotion. When he came to me for 
treatment, there was complete hemiplegia of the left side. 
There was no peculiarity in his gait, beyond a very slight 
dragging. The arm was slightly atrophied, and the amount 
of power exerted by a forcible grasp of the dynamometer was 
indicated by 15° of the lesser circle. He could not button his 
clothes, nor lift his arm above his head. There was no diffi- 
culty in speech, except it might be embarrassment in speaking 
the words containing the letters b and p, when the labial mus- 
cles were required. Electric irritability in the arm was slightly 
exaggerated. After giving him a simple prescription for his 
constipation, I dismissed him. In three weeks afterward he 
returned in very much the same condition. I then systemati- 
cally applied the galvanic current to the head, and the faradic 
to the limbs. The improvement was marked and immediate. 
The muscles lost their atrophic state, and became firmer and 
larger. The patient was able to perform many actions with his 



PARALYSIS. 77 

hands not possible before this treatment. Faradization to the 
lips and cheeks has effectually overcome the facial paralysis, 
and he now speaks distinctly. 

November 20th. — He is still under treatment, but improv- 
ing rapidly. 

III. Cerebral Softening — Bight Hemiplegia. — H. Walker, 
aged sixty-two, Germany, canal-boat captain, presented himself 
in December with a well-marked right hemiplegia. He had 
been injured some time before while on the deck of his canal- 
boat, and then hit upon the head. He was senseless for some 
days, but recovered, with severe cerebral disturbance, which, 
from his wife's statement, must have been inflammation of the 
cerebral substance. He left his bed after some weeks, with per- 
sistent pain in the head, trembling, and a heavy feeling of the 
lower limbs. His memory and other mental faculties became 
obscured, and there was an uneasy expression of the eyes. 
About a year after the receipt of his original injury, while 
working one day in the sun, he had an apoplectic attack. Af- 
ter remaining in bed some time, muscular power and cutane- 
ous sensibility slowly came back. He was able to walk with 
difficulty ; his speech was thick and indistinct, partaking of the 
stammering which occurs with softening sometimes. The mus- 
cles of both the leg and arm were greatly atrophied, and I de- 
termined to use faradism. The constant use of the very mild 
current for several weeks brought back, to some degree, the 
original contour of the paralyzed muscles. He was able to 
progress with a cane, but his speech remained imperfect. Dur- 
ing the treatment, he had repeated premonitory signs of a new 
attack, and I was surprised by this state of affairs. Faradism 
was resorted to, to prevent atrophy, but its good effects are 
only temporary, as there is still softening. 

TV. Right Hemiplegia — Cure. — " B. W., 1 a gentleman, aged 
sixty-eight, of gouty constitution, first came under my care in 
June, 1866. He was then suffering a good deal from gravel, 
and excess of uric acid in the urine, and digestion and assimila- 
tion had been imperfect for five or six years. In December, 
1866, while dressing for dinner, he had an apoplectic seizure, 
accompanied with loss of consciousness and paralysis of the 

1 Althaus's " Medical Electricity," p. 450. 



78 CLINICAL ELECTRO-THERAPEUTICS. 

left side of the body. For a week tie was in a very precarious 
condition, and I believe his life was only saved by large doses 
of ammonia and chloric ether, which I ordered to be given at 
short intervals. He gradually, however, recovered his con- 
sciousness and intellect ; the face resumed its normal appear- 
ance, and the muscles of the arm also improved. Four months 
after the attack, he was in the following condition : His mem- 
ory and speech were unaffected, and there were no distressing 
sensations in the head. The skin of the left arm and leg was 
cold and flabby, and the pulse weaker in the left than in the 
right side. There was a feeling of numbness, and a certain de- 
gree of ansesthesia, in the left arm and leg. The muscles were 
relaxed and somewhat wasted, especially the extensors, but 
there was no rigidity either in the upper or in the lower ex- 
tremity. Feeding, dressing, and all other movements of the 
arm and hand were extremely difficult, although with a great 
amount of exertion they could be performed. The patient 
could walk comfortably for half a mile, but then began to feel 
fatigued, and was obliged to rest. From these symptoms I 
concluded that the clot which had been formed in the right 
corpus striatum and thalamus opticus, and which had produced 
the paralysis, had, to a great extent, been absorbed. If, there- 
fore, the original injury had been repaired, the seat of the pa- 
ralysis was now not so much in the brain as in the motor 
nerves and muscles, which had been weakened by their lcng 
disuse. Faradization was therefore now resorted to, with the 
result that, after sixteen applications, the bulk of the muscles 
was increased, the circulation in the limbs was properly rees- 
tablished, and the patient had almost entirely recovered his 
motive power." 

SPINAL PARALYSIS. 

If the paralysis be due to actual disease of the cord itself, 
I do not believe that electricity will be of any avail, except, 
as I have before said, we treat the bad effects that follow such 
disease, e. g., atrophy. With these severe cases, there is more 
paralysis of sensation than with other varieties of disease where 
there is no lesion of the cord. A tumor in the substance of the 
cord is a formidable obstruction to success. Cases due to mye- 



PARALYSIS. 



79 



litis are good ones, as are those following or occurring with 
spinal ansemia. Kecent cases, and young subjects, are cured 
in the shortest time, and galvanism has succeeded better than 
faradism. 

Perij)heral Paralysis. — In the form of paralysis due to 
lead-poisoning, traumatic injury of the nerve, etc., etc., I have 
been most agreeably impressed with the efficacy of the faradic 
current combined with galvanism. Lead-poisoning is also treat- 
ed by the electro-chemical bath. In this disease it is difficult 
at first to obtain response to the faradic current. It is only 
when the faradic current is slowly interrupted that electro-mus- 
cular contractility is shown ; afterward, when the heightened 
excitability is diminished, it is well to follow up with the fara- 
dic current. "With these facts in view, it will seem evident 
that the current should be the direct, i. e., with the course of 
the nerve-current. Faradization and galvanization of special 
parts affected, must also be made. 

" The prognosis of lead-paralysis is always good, provided 
the muscles can be made to respond at all to the induced cur- 
rent ; and it is still favorable, though more time must be al- 
lowed, if they will respond only to the primary current. But, 
if no response can be evoked by as powerful a galvanic current 
as it is safe to apply, then it is well to give up the case." 

The following table, based upon the researches of Dr. Ham- 
mond, will enable the reader to estimate the length of time re- 
quired in an average number of favorable cases taken from that 
gentleman's case-book : * 



Induced Current. 


Primary Current. 


Condition of Patient. 


Time of Cure. 


No contractions. 
Feeble 


Powerful contractions. 

It u 


Atrophy of all the extensors of 
wrist and adductors of thumb. 


4 months. 
6 " 


No contractions. 

No 

No 

Contractions. 


U H 

it ' (t 


Extensors of wrist affected. 
Kesult of using lead cosmetics. 

11 11 II u 


2i " 

3 months 20 days. 

2-} months. 

6 weeks. 



Judging from this, the cases that recover the soonest are 
those that respond at once to the faradic current ; and those 

1 Clinical lecture, Bellevue Hospital Medical College. Reported in the Psycho- 
logical Journal, June, 1871. 



80 CLINICAL ELECTRO-THERAPEUTICS. 

that respond only to the galvanic current at first, take nearly 
twice the time. 

Paralysis from Lead-Poisoning? — "M. C, aged thirty-two 
years, single, born in Ireland, a painter by occupation. He 
has been moderately temperate in his habits, and has always 
enjoyed very good health until 1863, when he was suddenly 
seized with a very severe attack of colic, which was preceded 
by great constipation of the bowels and loss of appetite. 
There soon succeeded nausea and vomiting of bile, accom- 
panied by an acute lancinating pain in the epigastric region, 
which was so severe that the patient was obliged to lie flat on 
the floor, and press his abdomen strongly against that surface 
in order to obtain temporary relief. 

" These symptoms continued off and on for a period of 
about two weeks, gradually diminishing in severity, however, 
especially after an evacuation from the rectum, which was only 
obtained with the greatest difficulty. His right leg at this time 
became oedematous. In the course of two months he resumed 
his usual avocation, that of a painter, but was not aware, at 
this time, that his sickness had been caused by the action of 
lead. During the year 1867 his bowels again became very cos- 
tive, and his stools, which consisted of only a few lumps of dry, 
hardened fseces, were attended with much straining. Soon 
there followed a second attack much more severe than the 
first, which was characterized by nearly similar symptoms, 
only there was superadded great tenderness over the kidneys, 
which were so sensitive that the least pressure caused him the 
most intense agony. The urine was very scanty and high- 
colored, and there was a well-marked blue discoloration of the 
gums. 

"In a few mouths, having somewhat recovered, he went to 
work again at his former occupation, which he pursued uninter- 
ruptedly until the 25th of December, 1869, when, after having 
passed a very uncomfortable day, his former symptoms returned 
with increased violence, while the paroxysms of colic came on 
at much shorter intervals than they had done in the preceding 
seizures ; in fact, instead of intermissions as formerly, there 
were only remissions of the intestinal spasm. For the first 

1 Reported in the Psychological Journal, January, 1871, by Dr. Cross. 



PARALYSIS. 81 

time, lie had pain in the feet and the inside of his thighs. The 
urine was more scanty and higher colored, and the bowels more 
constipated than before. 

" In three weeks he again began to work, and had no more 
trouble, except constipation of the bowels, and weakness in 
both his upper and lower extremities, until July, 1870, when 
he lost his appetite, and felt very weary and exhausted after 
any small amount of exertion. He Was very restless, and could 
not sleep at night, and this inability to sleep was a sequela of 
all the other seizures. Now came great tremor of the right 
hand and arm, which was soon followed by tremor in the left. 
In August, 1870, he had his fourth and last attack, which was 
the most severe of all, and lasted about two weeks. This time 
he vomited blood, had acute pains in the soles of the feet, and 
cramps in the right hand. 

" On recovering from the immediate effects of the colic, he 
found that he was unable to use his arm or hand at all, and 
that he had lost power in his legs also. Soon after this he was 
admitted to the Charity Hospital, where he remained for a fort- 
night, and during his residence in that institution he became 
delirious, and continued so for about eighteen hours. 

"He came to the outdoor department of the New York 
State Hospital for Diseases of the Nervous System, September 
12, 1870, when his condition was as follows : 

" There was the characteristic drooping of both wrists, 
which was very extreme in degree. The paralysis of the supi- 
nator and extensor muscles of both upper extremities was ex- 
ceedingly well marked ; the flexors were also involved, only to 
a much more limited extent. The paralysis was more consid- 
erable in the right forearm and hand than in the left. There 
was much atrophy of all the muscles of these parts, and 
this was very conspicuous in the abductors and adductors of 
the thumbs. The patient was so very weak in his lower ex- 
tremities, that he was unable to arise from the sitting posture 
without assistance, and as he walked he tottered at every step. 
Yet, he did not drag the toe of either foot, nor swing his legs, 
as do those suffering from hemiplegia. The blue line was very 
plainly seen around the edge of the gums of the upper and 
lower jaws. On testing the amount of muscular power in the 
6 



82 CLINICAL ELECTRO-THERAPEUTICS. 

right hand by means of the dynamometer, he was able to turn 
the indicator only 10°, while with the left he could accomplish 
somewhat more. The tactile sensibility, sensibility to the elec- 
tric current, and to pain, were very greatly diminished. The 
temperature was also diminished ; muscular contractility was 
so much impaired that a powerful induced current had not the 
slightest effect in causing contractions, and, even when the pri- 
mary galvanic current (sixty cells and very strong) was used, 
the muscles responded very feebly, if we except, perhaps, the 
flexors, so almost completely had their irritability been de- 
stroyed. The bowels were regular, the urine was normal, and, 
although no chemical analysis for lead was made, undoubtedly 
it would have been found. 

" The appearance of the patient was ansemic, cachectic, and 
depressed ; the breath was very offensive ; the retinae were anse- 
mic ; the lungs were healthy, and so was the heart, excepting 
an inorganic murmur at its base." 

The treatment in this case has consisted of the internal ad- 
ministration of the iodide of potassium, commencing with ten- 
grain doses three times a day, and the daily application of the 
primary galvanic current to the paralyzed muscles, with a hypo- 
dermic injection of the thirty-second of a grain of the sulphate 
of strychnia every day. 

September 17th. — The iodide was increased to fifteen grains 
three times a day. 

September %Uh. — Slight fibrillary contractions in the right 
arm were produced to-day for the first time, by means of the 
faradic current. 

October 1st. — The iodide of potassium was increased to 
twenty grains three times a day. 

October 5th. — The induced current had just commenced to 
cause slight contractions in the left forearm. 

November loth. — Faradization of the left forearm produced 
good contractions in the extensor corpi radialis and ulnarius 
muscles. The blue line having disappeared, the iodide of po- 
tassium was discontinued, and a tonic substituted. 

November 23d. — The muscles of both arms respond feebly 
to the induced current, yet by means of it the hands can now 
be extended nearly on a level with the forearms. The right 



PARALYSIS. 83 

arm has improved the most. Sensibility to touch and to elec- 
tricity has much improved. His bowels are regular, he sleeps 
well, and his appetite is good. The power in both hands has 
much increased, and he is able to work every day, although he 
is still under treatment. 

January 1, 1871. — The patient has almost entirely recov- 
ered. % 

Hysterical Paralysis. — -In young girls capable of great emo- 
tional excitement, or disturbance, we sometimes meet with this 
disorder. It is not confined to any special part, but may attack 
one leg or arm, or only one or two muscles of the body. It 
usually takes, however, the form of paraplegia. This species 
of paralysis is purely functional, and the victim may recover 
without any treatment at all, or it may be a long, distressing 
malady, suddenly ending in an unaccountable manner. It is 
often associated with globus hystericus, and other disorders of 
a like nature. We should use the dry metallic excitor, or the 
brush, to the muscles themselves, and apply galvanism to the 
spine. Dr. Swain has reported a case in the Practitioner, 
which is as follows : 

" Hysterical Paraplegia in a Patient suffering with Epilep- 
tic Mania. — E. S., a girl of sixteen years of age, suffering from 
epileptic mania, and never having menstruated, was admitted 
into the Brookwood Asylum in October, 1868, being unable* to 
use either of her legs, and having in consequence to be carried 
into the ward on her arrival. Medicine was given to her to 
open her bowels, and, as she was very restless, a single dose of 
twenty minims of the liquor opii was administered : this pro- 
duced sleep. She was anaemic, and generally weakly in ap- 
pearance. She was both wet and dirty in her personal habits, 
but whether this was due to the same cause as the paralysis, or 
to her mental disease, it is not possible to say. A few days 
after her admission, the use of the electro-magnetic machine 
was commenced, and was persevered in daily until her entire 
recovery. It was first tried by her taking hold of the handles ; 
this produced no effect. The handles were then placed to her 
feet, but for about six days she did not feel any current at all. 
At the end of that time, however, she experienced a tingling 
sensation ; the machine was used alternately to the feet, hips, 



84 CLINICAL ELECTKO-THERAPEUTICS. 

and knees. About the end of December, she was enabled to 
crawl about, and employ herself a little in cleaning the floors 
of the infirmary in which she was placed. She gradually im- 
proved, and during the second week in March she had her first 
catamenial period. In the beginning of April she suddenly 
discarded her crutches, which she had used for two or three 
months ; and, at a ball given to the patients in the following 
week, danced several times, appearing to have quite recovered 
both sensation and motion. It is needless to say she was much 
tired after dancing. The epilepsy continued, with occasional 
attacks of excitement, until December, when she was discharged 
as recovered. She has since been a patient in the asylum, suf- 
fering from the same form of mental disease, but having exhib- 
ited no recurrence of loss of power over her limbs. 

" It would appear that recovery was not, in this case, due to 
the appearance of the catamenia, as before that period there 
had been gradual improvement ; and the actual ability to use 
the legs properly did not occur until three weeks after the 
menstrual period ; therefore, one is led to think that the elec- 
tro-magnetism must have exerted a decidedly beneficial effect. 
The dirty habits continued only a short time after a certain 
amount of sensation had returned to the limbs." 

Infantile Paralysis. — Infantile paralysis has a number of 
causes, consequently it is not always idiopathic. It may be 
due to injury, to reflex excitability, or rheumatism. This pa- 
ralysis may be partial, or it may assume a general character. 
It appears also as an incomplete hemiplegia or paraplegia. 
As in adults, some cases terminate in deformity. 

Probably no disease tries the patience of the physician as 
does this ; the cure is often tardy or incomplete, in spite of the 
fact that muscular nutrition is so marked in the child. It is 
often months before any result is obtained. 

Most of the cases that are brought for treatment are due to 
reflex causes ; for example, ascarides or dentition. These are 
the best subjects for electro-medication. 

Cases of paralysis of the deltoid, rhomboidii, and trapezii, 
muscles are hopeful ones for treatment. In this condition the 
relative position of the scapula with the thoracic walls and 
spines of the vertebrse is changed. The scapula can be kept 



PARALYSIS. 85 

in place by exertion of the will, but falls back to its malposi- 
tion immediately afterward. 

Faradization of the muscle for a long time was opposed, 
both on account of the youth of the patients, and the fact that 
the severe shock upon the nervous system was apt to be fol- 
lowed by convulsions. Duchenne insisted that, with proper 
care, the use of moist conductors, and the abolishment of the 
old severe system of dry conductors and metallic excitors, these 
cases could be treated safely. The induced currents are those 
that are to be employed (the primary and secondary). The 
instrument should be capable of producing slow interruptions. 
The secondary current produces deeper contractions than the 
primary. 

Emanuel Klopsch, 1 directeur de V Institute a Breslau^ made 
a very favorable prognosis for the electro-therapeutics of idio- 
pathic paralysis of children by the following case : The patient 
was a girl, nine years of age, who had been paralyzed in both 
legs nine months before the application of electricity ; the cause 
being, as M. Klopsch believed, a serous effusion in the spinal 
canal. This author, by faradization of the paralyzed extremi- 
ties, effected a restoration of the sensibility in fifteen days. It 
is to be remarked that localized faradization was used inter- 
mittently and alternately with electric foot-baths, douches, and 
gymnastic exercises. After four weeks, the patient could stand, 
and in thirty-four days she began to walk, without crutches or 
the aid of a stick. Finally, at the end of two and a half months, 
she walked alone. 

The same author reports the following cases : "Wally Kreu- 
sel, aged twelve years, had a fall on a stone step. i5y degrees, 
paralysis supervened, with atrophy of the left leg ; the patient 
dragged this leg, which was drawn up ; the left half of the pel- 
vis was depressed one and a half centimetre ; the circumfer- 
ence of the thigh and of the leg was shortened to the same ex- 
tent, besides which she suffered pain the whole length of the 
sciatic nerve. Faradization of the muscle supplied by this nerve, 
and the direction of the current of the electric foot-bath toward 
the trunk of the same nerve, both accompanied with gymnas- 
tics, accomplished a complete cure at the end of eight weeks. 

1 UUsberger's Prize Essay. 



86 CLINICAL ELECTRO-THERAPEUTICS. 

The paralysis disappeared, together with the atrophy ; all 
functional derangement ceased, as well as the pains. 

" A girl, four years of age, had been, at the end of eight 
months, suddenly, without any known cause, after a slight in- 
disposition, deprived of power in the left leg. Ten months 
after, the limb lost all power of motion. The child could not 
stand upright. The leg was visibly emaciated, but on measure- 
ment no notable difference was perceptible in its length. Elec- 
trization of the leg would not produce any motion of the foot, 
but would feebly flex the leg on the thigh. Faradization for 
some weeks restored motion at the knee-joint, and the power 
of flexing the thigh upon the pelvis. The results of ulterior 
treatment have been most satisfactory : the child has greatly 
improved ; she walks with ease, and we are led to hope that, 
by persevering, the limbs will regain their normal proportions, 
and the flexor muscles of the left foot their antagonistic tonic 
force and voluntary movement." 

Case reported by Dr. Eudolphe Wecke, of St. Petersburg : 
" A land-owner's son, aged five years, of scrofulous cachexia, 
was paralyzed on the right side, three months after a stroke 
of nervous apoplexy. The arm and leg suffered an arrest of 
development, particularly the foot, which was always cold. 
The patient could walk, but very slowly, and always dragged 
the affected side. If he wished to advance more quickly, he 
would take two steps with the left foot. He presented a pale, 
weak face and form ; he was taciturn and timid, and cried easi- 
ly. Wecke attended him for a year and six months, at the 
end of which he was radically cured." 1 

Traumatic Paralysis. — This paralysis, which follows sur- 
gical operations or accidents, when a nerve has been divided or 
compressed by tumors or effusion, etc., is very often met with. 
The extent of the paralysis is always proportionate to the in- 
jury. This can be determined by the rules laid down in a for- 
mer chapter upon electric diagnosis. 

It is hard to expect that any very remarkable results will 
follow our treatment in these cases. When the reparative pro- 
cess is complete, or nearly so, the muscle, or set of muscles, 

1 The author's translation of Ullsberger's Prize Essay, American Journal of Ob- 
stetrics, August and May, 1872. 



PARALYSIS. 87 

will begin to come under the influence of the current. In the 
case of a syphilitic or gouty effusion, the catalytic effect of the 
galvanic current will sometimes remove such an effusion and 
reestablish conductivity of the vessels. Faradization at the 
time, when the nerve is restored (before the will can be brought 
to influence the muscular contraction), will prevent atrophy. 

Special Paralyses. — In ptosis following paralysis of the mo- 
tor oculi, it is difficult to give great benefit, as it is almost im- 
possible to reach this nerve. In the mean time, we must direct 
our treatment to the eye in a general manner, by the local 
bain electrique, 1 etc. There are several forms of paralysis of the 
muscles of the eye, that are nearly all due to specific tumors in 
the brain, or to rheumatic exudations, but sometimes come from 
over-exertion of this organ. 

"When these conditions are associated with facial paralysis, 
I have found that faradization of the seventh nerve would re- 
move them. Benedikt holds out galvanization as the best form 
of electrization, in the treatment of these affections. He applies 
the positive pole to the forehead, and draws the negative one 
over the eyelid. He insists that the application should be 
short and feeble. Althaus recommends faradization. 

Case of Traumatic Paralysis* — " L., forty-three years old, 
dislocated his left humerus by falling on his left shoulder. He 
had pain in the shoulder, and found it impossible to use his 
arm, and that felt cold. The dislocation was found to be sub- 
coracoid, and, after eight days, it was reduced. The pain 
ceased, but the paralysis continued. In the palm of the hand 
there was, after three weeks, considerable scaling of the epi- 
dermis. Pressure on the shoulder was not painful, but a strong 
grasp of the triceps and of the muscles of the forearm was un- 
pleasant. Occasionally, there was a sense of formication from 
the middle of the arm down the extensor side of the forearm 
to the ends of the fingers. The left arm could be raised in a 
straight line forward about half a foot, but could not be car- 
ried backward nor across the breast. The forearm could not 
be bent on the arm, only the supinator longus was rendered 
tense. Extension was impossible ; supination was slight. The 

1 Described in the chapter on electrodes. 

2 Reported by M. Bernhardt, Berliner Klinische Wochenschrift, No. 5, 1871. 



88 CLINICAL ELECTRO-THERAPEUTICS. 

hand could be raised somewhat. Abduction and adduction of 
the hand, flexion and extension of the fingers, were impossible. 
The prick of a needle was felt to the upper border of the lower 
third of the arm on both sides equally. In the lower third of 
the left arm, in the elbow-joint, and the upper part of the fore- 
arm, the skin is more sensitive on the right than the left. In 
the rest of the forearm, in the hand and fingers, the sensation 
is a little less on the left than right, but nearly equal. The 
muscles of the arm and forearm, of the hand and finger, as well 
as the deltoid, showed only the slightest reaction to the induc- 
tion-current. Likewise, the use of a very strong galvanic cur- 
rent either to nerve or muscle, by opening or closing, failed to 
produce contraction. 

" From the 5th of January, every other day the patient was 
treated with a strong galvanic current, the anode and the ca- 
thode being placed on the paralyzed muscles. After four 
weeks he could raise the arm forty degrees, also some distance 
backward, so as to touch the right shoulder with the left hand. 
Also, he could bend the forearm on the arm, and had some 
motion in the hand and fingers. After eight weeks more, mo- 
tion was nearly restored." 

II. " F., 1 sixty years old, fell on the left shoulder. There 
was found sub-coracoid dislocation five days later. There was 
no power to move the arm at the shoulder, and only slight 
power over the forearm and hand. Numbness, with pricking, 
was felt in the forearm and hand. There was but little im- 
provement under the galvanic treatment." 

Facial Paralysis. — This disease, which may be produced 
by exposure, exudation, or pressure of the seventh cranial nerve 
in some bony canal by the product of inflammation, has its seat 
usually in the Fallopian canal. A syphilitic tumor in the cere- 
bral substance may also make this pressure. In this case our 
treatment must be specific. 

I have had very good results from the combined use of the 
two currents, using galvanism for the nerve, and applying it 
to the nerve itself, and to the chorda tympani, for the deafness 
that usually accompanies the disease, and the latter (faradiza- 
tion) to the muscles of the face. We may use it, as recom- 

1 Case of M. Bernhardt {Berliner Klinische Wochenschrift, No. 5, 18*71). 



PARALYSIS. 89 

mended in a previous chapter, one pole behind the angle of the 
jaw, and the other to the paralyzed muscle. "When facial pa- 
ralysis occurs with hemiplegia or locomotor ataxia, it is not 
wise to employ this treatment, unless the lesion is ancient. In 
facial paralysis from injury, galvanization is a better remedy 
than faradization. The following case is one in which this 
form of treatment was successful : 

Wm. O. In graham, aged thirty, United States, boatman. 
Previous history : He has never been seriously ill, but ten 
years ago he had a chancre, followed by marked secondary 
symptoms. The only other ailment was a severe attack of 
rheumatism, occurring three years ago. This was undoubtedly 
a tertiary symptom. 

His present difficulty began three months ago. ' At night 
he was disturbed by intense cephalic pains, dizziness, and dis- 
ordered vision. For several days the pains were steady and 
most violent under either temple ; he was also annoyed by 
post-aural pains. He then found that his hearing was becom- 
ing less acute, till the lesion finally occurred. This took place 
toward the latter part of July, 1870. 

He awoke in the morning, and felt a pain in the head, at- 
tended by swelling and puffiness of the face. His attention was 
called by several of his associates to the " crookedness of his 
face." He looked in the glass, and saw the drooping of the 
left side of the face, with complete paralysis of the muscles at 
the corner of the mouth ; then followed total loss of hearing. 
He could not appreciate the loudest noises when the sound ear 
was closed. The paralysis increased every day. A few days af- 
ter this, the eyelid drooped, and he found it impossible to open 
or completely shut the eye. It became congested and irritated, 
and he experienced a burning sensation, with photophobia. 

His condition grew gradually worse, till he was compelled 
to leave his employment, and seek medical aid. He never had 
had otorrhcea or ear-affections of any kind, nor had been par- 
alyzed. His habits were good, and his hereditary history fa- 
vorable. 

"WTien he applied to me, I found paralysis of the entire 
seventh nerve, motor ocularius, and disturbance of the sympa- 
thetic of the eye. There was no antagonistic force of the or- 



90 CLINICAL ELECTRO-THERAPEUTICS. 

bicularis oris, levator labii superioris et alseque nasi, or masseter 
muscles. He could hardly insert the finger in the mouth with- 
out pulling down the jaw with the other hand. He experienced 
a difficulty in mastication and deglutition, from involvement of 
the left side of the tongue, which, when protruded, inclined to 
the right side ; with this there was indistinct articulation, and 
I was led to infer paralysis of the lingualis muscle. 

From the patient's previous history I was led to suppose 
that syphilis was the primary cause of the trouble, and, from 
the depth of the lesion, that the seventh nerve was paralyzed 
at a point above its division. 

From the specific features of his case I deemed the iodide 
of potassium to be the best remedy, and he was therefore put 
upon grs.V, thrice daily. Hypodermic injections of strychnia 
and morphia (-^ of , a grain of the former to -^ of the latter) 
did much good in relieving the severe cephalalgia. Localized 
galvanization was resorted to, and both the primary and sec- 
ondary currents used. After the nerve and its branches had 
been pencilled over with stick-caustic, one electrode was ap- 
plied to the ramifications of the nerve, while the other was 
placed over the mastoid process. So successful was this treat- 
ment that, after a daily seance lasting twenty minutes, in three 
weeks the patient's face was much more symmetrical, and the 
act of mastication was improved. 

The pains likewise disappeared under the same current. 
Occasional directions of this and the faradic current over the 
eyelid did much toward the improvement of sight. 

It now occurred to me that Matteucci's experiment upon 
the ear might be followed by gratifying results ; so its cavity 
was filled with water, and one of the battery-wires finely covered 
with sponge was gently introduced into the external meatus. 
After four weeks his hearing was so markedly improved that he 
easily distinguished loud voices, when the sound ear was closed. 

November 12th (seven weeks after commencement of treat- 
ment). — During the application of the current the face resumed 
its expression, and he was able to close his eye completely. He 
is greatly improved. Injections discontinued. He has almost 
complete control over the levator palpebrse — this is more 
marked in the morning — articulation good. 



PARALYSIS. 91 

November 28th. — Has now taken the battery for nearly ten 
weeks, and is about to discontinue treatment. The face is per- 
fectly symmetrical, and the hearing nearly as perfect as ever — 
the only remaining disfigurement is a slight drooping of the 
eyelid on the affected side. Appetite good, and, though ema- 
ciated at first, he has now completely regained his former good 
condition. 

In this case the cause was evidently syphilitic ; but, though 
the central lesion was cured by iodide of potash, I can clearly 
lay the restoration of the paralyzed nerve to galvanism and 
faradization. 

Althaus * reports the following case, where the disease fol- 
lowed exposure : ' 

" Wm. F., a barrister, aged thirty-five, having been exposed 
to a draught of cold air at a railway-station, became affected 
with paralysis of the left portio dura. The physiognomical ex- 
pression had entirely vanished from that side of the face. The 
patient was not able to laugh, frown, whistle, or shut his eye, 
which latter appeared staring and protruded. The angle of 
the mouth was depressed, and drawn toward the opposite side ; 
that of the sound side being higher, and drawn toward the ear/ 
The cheek was flabby and loose, and eating and speaking were 
troublesome. The patient was sent to me by Dr. Todd, whom 
he had consulted six months after the commencement of the 
affection. Farado-muscular contractility was diminished. I 
directed the faradic stimulus to all the paralyzed muscles indi- 
vidually, with the effect that the patient regained his normal 
physiognomical expression after a fortnight's treatment." 

Captain T. D., aged forty-three, born in Ireland. On 
awakening one morning in July, he found something strange 
about his face, but did not realize at that time what it was ; his 
friends told him, however, and he discovered that it was twist- 
ed to the left side. He applied at the New York State Hospi- 
tal for Diseases of the Nervous System four days afterward, 
when he presented all the symptoms of facial paralysis. Dr. 
T. M. B. Cross, under whose charge he was, treated him with 
galvanism, both the primary and induced currents. In the 
course of a week he acquired the power of closing his right 

1 " Medical Electricity," p. 500. 



92 CLINICAL ELECTRO-THERAPEUTICS. 

eye voluntarily. He took strychnia and phosphoric acid inter- 
nally. After about twenty applications of galvanism, he was 
dismissed, with the power almost entirely restored to all the 
paralyzed muscles. He is now well, with the exception of 
slight paresis of the orbicularis-oris muscle. At first the in- 
duced current did not act, whereas the galvanic did from the 
very beginning. 

These two cases are identical in many respects, and may be 
considered good representative types of those usually met with. 

Reflex Paralysis. — This form commonly follows wounds, 
injuries, or other causes of irritation, and is due to the irrita- 
tion transmitted from the peripheral end of a nerve to the cord. 
It does not always disappear with the cause. Galvanism to the 
seat of irritation will relieve the condition. 

Paralysis of the Bladder. — Paralysis of the bladder occurs 
from three causes, viz. : 

1. Interruption of communication between the bladder and 
the cerebrum. 

2. Diseases of the lower part of the cord. 

3. An alteration of the excitability of the bladder without 
cerebral disease. 

The galvanic current is the best for the purpose of electriz- 
ing the bladder, and the results are brilliant and satisfactory. 
Faradization may, however, be used advantageously, particu- 
larly in cases of atony. In the dribbling of children it is of 
great service. Some authors condemn galvanization of the 
bladder, on the ground that it produces an electrolyzation of 
the urine. It may be well to empty the bladder and refill it 
with water before applying the current. 

Pheumatic Paralysis. — We obtain the most cheering re- 
sults from the use of electricity in this common malady. The 
localities usually affected are the extensor muscles of the fore- 
arm, which are supplied by the radial nerve, the muscles of the 
eyes, the deltoid, and trapezius muscles, and the small muscles 
of the hands. These latter rapidly atrophy, if the paralysis is 
not treated at once. The electric irritability of these muscles 
is nearly always greatly heightened. Faradization is the best 
variety of electricity for this disease, and in nearly every case 
it is successful. 



PARALYSIS. 93 

I. Thomas H., aged thirty, had a severe attack of acute 
rheumatism before he presented himself to me. He had been 
a sailor, and constantly exposed to rain and cold. After his 
disease, for which he received but little treatment on shipboard, 
he resumed his. duties. He found, a week subsequently, that 
his arm was without sensation, and that he could not use his 
hands as he had been in the habit of doing. 

When he left his ship, I saw him, and found considerable 
atrophy of the muscles of the forearm, and great loss of cuta- 
neous sensibility. The patient was treated for a little less than 
a month, and the recovery was complete. 1 

II. Case reported by Althaus. 2 — " Mrs. G-., aged fifty-one, 
was sent to me by Dr. Hyde Salter, in January, 1862. Three 
months before, she had suffered from a severe attack of rheu- 
matic fever, nearly all the joints having been affected. As 
soon as she was able to move about again, she went into the 
country, where her general health much improved. Her right 
arm and hand, however, remained painful and useless, and 
she was therefore advised to try faradization. On examining 
the forearm and the hand with the sesthesiometer, I found 
that the sense of touch was considerably impaired. Moreover, 
the muscles were considerably wasted, more especially the 
flexors and the interossei and lumbricals ; and, on applying 
the faradic current to these muscles individually, it appeared 
that their sensibility, as well as their contractile power, was 
very nearly gone. The hand had lost its natural shape, and 
resembled a bird's claw — a configuration of the hand which 
is always associated with loss of power in the interossei and 
lumbrical muscles, and renders it entirely useless. The pain 
was greatest at night, and chiefly felt in the fingers. The gen- 
eral health of the patient was tolerably good, but she was very 
thin, and suffered greatly from despondency. I used faradiza- 
tion of the skin for the cure of the pain, and of the suffering 
muscles for restoring them to their normal nutrition and func- 
tion. After two operations, the motor power of the fingers 
was much increased : the muscles responded more readily to 
the faradic stimulus, and the sesthesiometer showed an improve- 
ment in the sense of touch. The pain, although not entirely 

1 1 found none of the hyperesthesia that Duchenne mentions. 3 Althaus, p. 481. 



94 CLINICAL ELECTKO-THEKAPEUTICS. 

gone, was much diminished. After a fortnight's treatment 
(the patient attended every other day) she was able to cut her 
own meat, and to do some housework, and in a month she 
could do needle-work for three hours consecutively without 
feeling pain or fatigue. There was then no longer any differ- 
ence in the sense of touch in the right and left arms, the bulk 
of the muscles was much increased, and the hand had resumed 
its normal shape. This result was all the more satisfactory, as 
the age and general weakness of the patient were not in favor 
of a rapid cure." 

Dysphonia and Aphonia. — Both of these affections occur 
with partial or complete paralysis of the vocal cords. Whether 
resulting from diphtheritis or typhoid fever, over-exertion from 
prolonged use of the voice, terror, ansemia, or the results of 
metallic poisoning, they are amenable to faradization. Not so, 
however, are they when produced by the pressure of an aneu- 
rism, tumor, or of local morbid growths. Dr. Mackenzie, of 
London, has devoted himself to the treatment of these diseases, 
and his instruments are those we most use. The faradic cur- 
rent is that recommended. Dr. Mackenzie faradizes the glot- 
tis, and, of two hundred cases treated by him, but four were 
unsuccessful. Dr. George Johnson, in the Medical Times and 
Gazette, January 15, 1870, p. 61, relates a case of aphonia he 
treated with faradization ; its history is briefly as follows : 

" A boy, about twelve years of age, was much frightened, 
and nearly drowned, by falling into a pond. From that time 
he completely lost his voice, his intellect being unimpaired. 
When I saw him he had not uttered an audible sound for two 
years. I saw that his larynx was healthy, and I determined to 
apply electricity. The first shock elicited a loud scream, and 
at once he recovered his speech." 

In most cases it is necessary to apply the electricity again 
and again before the cure is complete, and in some cases the 
treatment is unsuccessful, but these are comparatively rare. 
When the general health is impaired, treatment should be di- 
rected to remedy this, while the electricity is being employed. 

Faradization has also been employed in glosso-ldbio-pharyn- 
geal paralysis, but usually without success. Dr. Gottner, 1 in 

1 Gazette Medicdle, Stat. April 20, 1872. 



PARALYSIS. 95 

spite of this fact, reports a case of pharyngeal paralysis success- 
fully treated by galvanization of the sympathetic. In a very 
short time the patient was able to swallow with ease. This 
was at about the forty -fourth day of the disease : after three 
applications the cure was completed." 

Progressive Locomotor Ataxia (Sclerosis). — Onimus has 
used galvanism in this disease with success. His plan is, to 
make application to the cord by the inverse current. This 
treatment can only afford temporary relief, and so far as I can 
ascertain there are but two cases where cures were effected, and 
these are reported by Benedikt, and Dr. Foot, of Dublin. The 
disease, when not due to acute disease of the cord, but to the 
influence of such maladies as diphtheritis, may yield to galvano- 
therapy, as Dr. Foot's did. True sclerosis of the cord, how- 
ever, is not amenable to treatment of this kind alone. Gal- 
vanism here can only be employed as an adjuvant. Dr. Ham- 
mond advises the constant current, of high tension. This 
should be applied to the spine. 

Progressive Muscular Atrophy. — Those cases of wasting 
paralysis having the above name depend upon a wasting of 
certain muscles or groups of muscles from extreme steady use 
and over-exertion. The affected muscles respond well to the 
current, as they are unchanged in point of contractility. Fara- 
dization will prevent the advance of the disease, and retard 
atrophy. Mr. Fagge reports the following case : ' 

" G. P. H., aged twenty-seven, admitted into clinical ward, 
under my care, June 12, 1867. He is a harness-maker. About 
eight weeks ago he began to feel weakness in his arms, and be- 
came unable to grasp firmly with his hands. He also had tin- 
gling sensations in his arms. The muscles of the forearms, 
except the supinator longus, were considerably atrophied ; and 
the interossei, and other muscles of the hand, were also much 
wasted. The movements of the hands were very imperfect ; 
for instance, he had great difficulty in unbuttoning his shirt. 
Tremor was not present in any marked degree ; I think I ob- 
served it slightly in one of the muscles of the left forearm. On 
testing the muscles with the continuous current, it was found 
that thirty-five to forty cells were required to produce contrac- 

1 London Practitioner, December, 1868. 



96 CLINICAL ELECTRO-THERAPEUTICS. 

tions in the extensors of the forearm ; whereas the biceps re- 
acted to twenty cells. The medicine which was prescribed for 
him, besides an occasional purgative, was a mixture containing 
three grains of iodide of potassium, which he took three times 
a day for seven days, when it was discontinued, in order that 
the value of the electrical treatment might be more surely test- 
ed. This treatment consisted in the application of the contin- 
uous current to the spine (according to Eemak's method) every 
day, for fifteen minutes at a time. It produced a strong gal- 
vanic taste, and a tingling sensation in the right arm (the elec- 
trode was applied beneath the right auricle). The forearms 
were wrapped in cotton-wool, and placed upon splints. After 
seven days of the treatment the splints were removed, and it 
was then found that there was decidedly more power in the 
grasp. At the end of sixteen days he could dress himself with 
ease, and could write tolerably well. He could not bear so 
strong a current as at first ; twenty-five cells now produced 
distinct contractions in the arms and legs simultaneously. The 
muscles were fast regaining their firmness and tone. He con- 
tinued to improve. On August 22d, it is noted that he could 
write several letters in a day. He went out nearly well, on 
September 21, 1867. I have since heard (October, 1868) that 
he has remained free from any further symptoms of the disease. 
Besides the affection of the arms, this man had likewise weakness 
of the lower limbs ; from this he recovered at the same time." 

Many of these cases have been treated at the New York 
State Hospital for Diseases of the Nervous System. The gal- 
vanic current produced marked restoration of the muscle. 

Benedikt 1 reports a case, the interest of which lies in the 
fact that the shoulder-muscles were those affected, that there 
was extensive vaso-motor paralysis in the face, neck, and shoul- 
der-blade, which quickly disappeared on galvanization of the 
cervical sympathetic. 

The reaction on opening the current with a gradually- 
increasing current at the anode became weaker or disappeared, 
to reappear again when the current became stronger. 

Locomotor Ataxy subsequent to Diphtheria — Recovery? — 

1 Wiener Medical Pres'se, 1872, p. 9. 

2 Reported by Dr. A. W. Foot, in Dublin Journal of Medical Science, September, 
1872, p. 176. 



PARALYSIS. 97 

" A private servant (coachman), aged thirty-one, height five feet 
ten inches and a half, weight ten stone six pounds, married, 
and father of children, was admitted into hospital March 22, 
1872, and put under the care of Dr. Charles A. McMunn. The 
circumstances which immediately led to his coming into hospi- 
tal were as follows : His mistress, observing with regret that 
the man appeared, from the unsteadiness of his gait, to be fre- 
quently under the influence of drink, asked the medical attend- 
ant of the family to advise her what to do about him. The 
doctor sent his son to see the man, and he reported that the 
man did not drink, but was, in his opinion, suffering from 
some spinal affection, and recommended him to be sent to hos- 
pital at once ; this was accordingly done. When the history 
of the case came to be investigated, it was ascertained that the 
man got a severe wetting at the Fairyhouse races, April 10, 
1871, which resulted in "a heavy cold" and "sore-throat," 
which sore throat was followed by dysphagia and regurgitation 
of fluids through the nostrils ; his food used also to " go the 
wrong way," and cause coughing. These symptoms occurred 
a fortnight after the " cold," and when he considered himself 
cured of it. An habitual perspiration of the feet and ankles 
became suppressed at this time, and had since remained so. 
For the next ten months or so he considered himself quite 
well ; but, when the proper inquiries had been made, it came 
out that within that time he had observed a marked diminution 
in sexual power ; also, that in descending stairs or steps his 
feet " were inclined to give way," and he often tripped, slipped, 
or missed his footing ; sometimes, also, when attending at table, 
he tramped heavily in walking about the dining-room, and was 
unusually awkward in holding or handling plates or dishes ; he 
also for some time suffered from amblyopia. So far, he had 
been able to perform his duties as coachman very well, fre- 
quently driving four-in-hand ; but, three weeks before admis- 
sion, he got another heavy wetting, not, however, followed by 
'cold." A week afterward he was on a ladder outside the 
house, cleaning windows, at a considerable height from the 
ground, when, feeling giddy, he got off the ladder and went 
into one of the rooms, where he fell on the floor ; after that he 
got a " numbness " in both hands, and could not " feel things 
7 



98 CLINICAL ELECTRO-THERAPEUTICS. 

rightly with them ; " he became hardly able to write, the pen 
slipping away from between his fingers because he could not 
hold it. 

"When examined upon admission, his heart was free from 
apparent disease, and its action not slower than usual, but evi- 
dence of weak circulation was present in his very purple hands 
and feet, which in cold weather, and when he has been at rest 
for some time, became quite livid. He walked in a staggering 
and unsteady manner, could not run, jump, or hop, although 
he used to be very active on his feet, and had won a flat-race 
< of one hundred and fifty yards before the "cold" in 1871. 
He had noticed his power of running to fail during the present 
year, and had observed that such exercise put him out of breath, 
and brought on palpitations. He could not get out of bed in 
the dark, nor stand steadily with his feet together, toe to toe, 
in the ataxy position, with his eyes shut, because, as he said, 
"the ground goes from under him," or "gives way under 
him ; " he feels " as if he was on a spring," or " on soft turf," or 
" on a feather-bed." None of these similes were in any way 
suggested to him, nor were any leading questions used to elicit 
the information sought for. "When he stood with his feet apart, 
and was supported on either side, the ground felt quite steady 
under him. A numbness extended over the feet, and to a 
•short distance above either ankle, occupying the tract which 
had been the situation of the habitual sweating, now almost a 
year suppressed. Both his hands were " numb," the left more 
so, and he was awkward and slow in execution of such digital 
movements as buttoning, writing, picking, and holding. The 
numbness was principally on the backs of the hands, and did 
not extend above the wrists. The sesthesiometer showed the 
deficiency in the sense of touch to be greater on the dorsal 
aspect of the right hand than of the left ; the two points were 
first appreciated at one inch fire lines, in the axis of the limb, 
on the former, and at one inch on the latter. The mean power 
of the right hand was 40.66 kilos. ; of the left, 52.00 kilos. This 
sinistral preeminence he accounted for by his having " a strong 
left hand," from the constant pull on that hand in driving ; 
much of it, however, was due to actual deficiency in the right 
hand, as was afterward shown by its restoration. He has mus- 



PARALYSIS. 99 

cular twitchings in both Lands and legs, no pains or cramps ex- 
cept a painful feeling of weakness across the back of the left 
hand, in the line of the metacarpo-phalangeal articulations. He 
had some difficulty in guiding food on his fork to his mouth, 
could not put the index-finger of his right hand to the tip of 
his nose with the eyes shut, either quickly or with certainty of 
aim ; he misses the mark at the first offer, but can hit it- off 
better with the left forefinger. Sense of touch impaired in the 
left hand, sensibility to temperature normal in both. His ar- 
ticulation had become affected within the three days prior to 
his admission ; he spoke with a hesitation, clipping his words ; 
he thinks his tongue and lips are swollen, and that this is the 
reason he " speaks thick ; " the tongue deviated slightly to the 
right side when protruded ; there was no obliquity of the uvula, 
or dropping of the soft palate ; the pillars of the fauces were a 
little redder than natural ; no alteration in tone of voice ; he 
could pronounce all the vowels distinctly. The right pupil was 
larger than the left one, which was of normal size ; it respond- 
ed to light, but was sluggish in its movements. "With the oph- 
thalmoscope, the margins of the disk in the left eye were ill- 
defined, the disk congested, and the veins very tortuous ; sight 
in both unaffected — no ptosis, strabismus, diplopia, or conges- 
tion of the conjunctiva. The functions of the bladder and rec- 
tum were undisturbed ; there was no constipation, nor belt-like 
sensation round the body, nor albumen in the urine. Pain 
"in the small of the back" was complained of; its anatomical 
locus was found to correspond with the spinous process of the 
first lumbar vertebra. 

Treatment and Progress. — At first the case was regarded as 
one of structural rather than functional disturbance of the spi- 
nal cord, as the history was not fully investigated, nor the clew 
of the remote attack of diphtheria traced until he had been 
some clays in hospital. Meanwhile he was ordered fifteen-drop 
doses, three times a day, of liquid extract of ergot of rye, be- 
cause I had observed the good results of this medicine in con- 
gested conditions of the cord. 

March 25th. — A galvanic current from thirty cells of a 
Smee's battery was passed along the back for fifteen minutes, 
with moistened conductors, the positive pole was applied over 



100 CLINICAL ELECTRO-THERAPEUTICS. 

the fifth cervical vertebra, the negative moved about over the 
lumbar vertebra ; this current was not felt, nor did the con- 
ductors redden the skin. 

26th. — He remarked that he 'had more power in his 
hands.' 

28th. — Can stand more steadily with his eyes shut. The 
lumbar pain is gone. A current of fifty cells was used in the 
same manner as before. lie scarcely felt the negative pole, 
and it only slightly reddened the skin. 

29th. — He finds he ' can write much better.' Stands more 
steadily. Current of fifty cells used. The same strength of 
current applied in the same manner to the previous case of 
locomotor ataxy was quite unbearable, thirty cells being the 
most he could at any time bear, although a much larger and 
more muscular man. 

30th. — His friends remark upon his improved appearance. 
Current of forty cells used. 

31st. — The habitual perspiration in the feet reappeared for 
the first time. 

April 1st. — The ergot was discontinued, and -^ grain of 
strychnia ordered twice a day. Galvanism to the spine con- 
tinued. 

2d. — Able to put his food into his mouth with his left hand. 
An analysis of his urine was made to-day. Urine of April 1st 
and 2d (twenty-four hours) = 34 fl. oz. acid ; spec. grav. (fil- 
tered) 1,027 ; turbid from abundance of pale urates ; no albu- 
men ; urea 31 grs. per 1,000 grs. urine, or total quantity = 
461-§- grains ; phosphoric acid 3.48 grs. per 1,000 grs. urine, or 
total quantity == 51.76 grains. 

4:th. — Able to take a walk of eight miles without fatigue. 
While out, he tried to run, but one foot got in front of the 
other and threw him down. 

1th. — Can button and unbutton his clothes without looking 
at them. 

9th. — Can feel any small thing, such as gravel, under his 
feet with his boots on. 

15th. — Fifteen-drop doses of the tincture of perchloride of 
iron ordered three times a day, in addition to his strychnia. 

16th. — The numbness has quite left his hand ; he can bal- 



PARALYSIS. 101 

ance himself on his toes ; the habitual perspiration of the feet 
is quite reestablished. 

l§th. — Went back to his situation for the day, in order to 
drive the carriage ; a pair of horses being required for a particu- 
lar occasion, which he was afraid to trust with the man who 
was acting for him in his absence. He was able to manage the 
horses very well. 

23^7. — His weight is found to have increased seven pounds 
since his admission ; he is now ten stone thirteen pounds. The 
dynamometer indicates with the right hand 59.66 kilogrammes, 
with the left, 53.33 kilogrammes ; showing an increase of pow- 
er in the right hand of 19 kilogrammes, and in the left of 1.33 
kilogramme. 

25th. — He returned to his situation ; a slight hesitation and 
clipping of his words remained, which I thought would be like- 
ly to disappear more quickly under the influence of country air 
and sea-bathing, both of which were at his command, than un- 
der any form of treatment in hospital. I have since heard that 
he is ' as well as ever.' 

Without claiming any active curative effect for galvanism 
in this case, it is proper to observe that he became more sensi- 
tive to it as his health improved, and that he expressed himself 
as ' refreshed after it as if he had had a bath.' It was used 
daily during his stay in hospital, and for fifteen minutes at a 
time ; the number of cells employed varied from thirty to fifty. 
The current was always applied to the spine with moist con- 
ductors ; the positive pole placed in the cervical region, the 
negative pole over the lumbar vertebras. The dilatation of the 
right pupil first directed my attention to the possibility of a 
diphtheritic origin of his symptoms, as the opposite condition 
of the pupil is that most frequently observed in true locomotor 
ataxy." 



CHAPTEE IX. 



HYPERESTHESIA, ETC. 



Neuralgia. — Its varieties. — Etiology. — Facial Neuralgia. — Cervico-brachial Neural- 
gia. — Intercostal Neuralgia. — Gastrodynia. — Tic-Musculaire. — Sciatica. — Rheu- 
matism. — Anaesthesia. — Anaesthesia of the Sensory Organs. — Asphyxia, etc. 

By the term hyperesthesia, we mean an exalted state of 
sensibility in the nerve itself, dependent upon some change be- 
tween its point of origin and periphery. It does not necessa- 
rily depend upon inflammation of the nerve, for the pain of 
hyperesthesia is different from that of inflammation. 

Neuralgia. — The seat of pain may be either superficial or 
deep. In the former case, the terminal twigs of the nerves are 
the parts affected, but in the latter form we must look for the 
lesion in the nerve- trunks or cerebro-spinal axis. Any cause 
that will congest the sheath of the nerve may produce neural- 
gia. Pressure is a frequent cause, and usually comes from the 
products of inflammation in bony canals, or at the point of 
emergence of a nerve from some foramen. Spiculse of bone, 
tumors, and deposits, will create the same disturbance. 

Oftentimes the disease is purely functional. "With the pro- 
duction of neuralgia by inflammation of certain organs, and 
when large nervous trunks are affected, the disease is obstinate 
and not always curable. The selection of the current has been 
a serious stumbling-block. Probably the opinion of Dr. Anstie 
is worth more to us, from his faithful pursuit of this specialty, 
and careful observation, than any other. 

Dr. Anstie observes : 1 " The constant current is a remedy 
for neuralgia unapproached in power by any other, except blis- 

1 " Neuralgia," etc., p. 200. 



HYPER JESTHESIA. 103 

tering and hypodermic morphia, and the latter is often sur- 
passed by it in the permanence of its effects, while it is appli- 
cable in not a few cases where blistering would be useless." 
Dr. Anstie condemns faradization. In the main, I have found 
it without effect in most cases ; it has served me well, however, 
in those cases of superficial hyperesthesia attended by a certain 
sluggishness of the circulation. Here I have used it with the 
dry excitors or brousse, and have been successful. 

Benedikt insists that the application should be made to the 
point of disease. As the posterior nerve-root is essentially the 
seat in deeply-located neuralgias, we should endeavor to bring 
this particular part within the circuit. In cases of brachio- 
cervical neuralgia that have come under my care, I have found 
that, when the pole was applied over the brachial plexus, the re- 
sult was better than when the nerves were directly electrized. 

Althaus recommends that the positive pole should be inva- 
riably applied to the painful point, and still further shows that 
the negative pole would produce an excitement that would in- 
crease the severity of the pain. Dr. Russell Reynolds thinks 
that there is no appreciable difference in the direction of the 
current as far as its good effects are concerned, whether it be 
direct or inverse. I have found, in many of my cases, that, 
when the inverse current was used, the severity of the shock 
aggravated the pain notably. I found this particularly in a 
case of facial neuralgia, that had existed for years. The direct 
current ameliorated this condition of the patient, while the in- 
verse acted contrariwise. 

My best results have been obtained from a use of the con- 
stant current continuously applied for from five to ten minutes. 
I vary the position of the poles where the pain is concentrated 
at some point. The current should not be so strong as to pro- 
duce burning or pain. It should cause simply a tingling sen- 
sation, with slight redness under the negative pole. The appli- 
cation should be made at least three times a week, or daily, if 
possible. A large sponge-covered electrode may be employed, 
or, if concentrated local action is desired, either Duchenne's 
points or a small cylindrical sponge-electrode may be made 
use of. 

Altogether, the form of neuralgia most generally met with 



104 CLINICAL ELECTRO-THERAPEUTICS. 

is facial neuralgia. This may depend upon a number of 
causes ; perhaps malarious influences or exposure to cold, or in 
some cases a carious tooth is the origin of the neuralgia. Men- 
tal excitement and functional disorders are also frequent causes, 
and in most cases the disease may be traced to them when 
women are the sufferers. There is another form of neuralgia 
which is a concomitant of old age. Galvanism is of use in 
all these cases. In the former varieties, faradism is indicated 
sometimes. There are many obstinate cases that come under 
the head of epileptiform neuralgia. They require a most per- 
sistent course of galvanization. The latter is preferable to 
division of the nerve, for, according to Althaus, it alters the 
nutrition of the affected part. It is well to make the applica- 
tion of one pole to the supra-orbital point of emergence when 
this nerve is affected, and this should be the positive pole. 

In the treatment of painful diseases of the nerves, we should 
differentiate between neuritis and neuralgia. This may be done 
by the galvanic current. Patients suffering with neuritis can 
hardly bear the same strength of current which would soothe 
and relieve a neuralgic condition. In neuritis, then, the appli- 
cation should be short, and the current of low tension. Mild 
cases of headache may be cured by faradization of the face by 
a soft sponge, or the " electric hand." 

Oervico-brachial neuralgia is a persistent variety of neu- 
ralgia that often resists all forms of treatment. The continu- 
ous current is competent, however, to effect a rapid ameliora- 
tion. One pole may be held over the brachial plexus, and the 
other applied to the course of the nerve by means of a fine- 
pointed sponge-electrode. I have found hypodermic injections 
of atropia to hasten recovery wonderfully. 

Intercostal neuralgia, gastrodynia, and pleurodynia, all yield 
most rapidly to both the currents. In the latter, the posi- 
tive pole is to be applied to the solar plexus. In pleurodynia 
and intercostal neuralgia, we may use Duchenne's method or 
plan — one pole on the nape of the neck, and the other to the 
painful spot. My friend Dr. Roger Tracy gives me the par- 
ticulars of his treatment of a young girl for pleurodynia. She 
had been put upon courses of iron, strychnia, and belladonna- 
plaster, but all failed to relieve her ; finally he used the faradic 



HYPERESTHESIA. 105 

current as recommended above, the negative pole being placed 
upon the painful part, and the positive to the nape of the neck. 
One application removed all pain, and at her next visit she said 
that she had had no return. 

Tic Musculaire. — All neuralgic or inflammatory conditions 
of muscles are readily amenable to faradization, and the most 
painful twinges will often disappear after fifteen minutes' use 
of the current. 

Sciatica. — Probably one of the most obstinate diseases we 
have to contend with is this neuralgic disease of the sciatic 
nerve. Usually it results from some deep-seated inflammation 
or derangement of one or more of the pelvic organs ; in this 
case it is reflex ; at other times rheumatism or an inflammation 
of the loose tissue that surrounds the nerves w T ill produce the 
disease, or it may even occur with paralysis. In our treatment 
we must be guided by these conditions. The exciting cause is 
to be treated by other remedies than galvanism. Many weeks 
are usually required to perform a cure, and, during this time, 
we must persistently use the continuous current applied over 
the track of the nerve by means of conical sponge-covered elec- 
trodes. In the severer form of sciatica, as well as neuralgia, 
there is often an anaesthesia of the skin, with coldness. If the 
arm or leg is carefully kept in cotton-batting during the inter- 
vals between the seances, the patient will be greatly relieved. 

I. Cervico-hrachial Neuralgia. — Mrs. Gr. consulted me in 
June for cervico-brachial neuralgia. This patient had been af- 
fected with the disease for many years. So exquisitely hyperaes- 
thetic was the entire arm, that she could hardly bear the weight 
of her dress. If her fingers were touched roughly, a most ex- 
cruciating twinge of the entire median nerve would follow. She 
was deprived of sleep by excessive pain, and had become anae- 
mic and emaciated. Iron and strychnia, and the various nar- 
cotics, had given her no relief. The application of the moder- 
ately strong faradic current aggravated the pain, but a reduction 
in the force of the current soothed and lulled it. I applied the 
galvanic current (descending current) by means of wet sponges. 
The first application of fifteen minutes, with twenty cells, gave 
her almost instantaneous relief. Seances, every other day, in 
less than three months effected a permanent cure. 



106 CLINICAL ELECTRO-THERAPEUTICS. 

II. Facial Neuralgia. — Dr. Joseph Stead, 1 of Manchester, 
reports the following case of facial nenralgia : " The patient was 
a girl of twenty-four, and had been suffering from facial neu- 
ralgia of both sides for three months. For two nights previous 
to her visit to me, she had been compelled to get up from bed 
and come down-stairs and spend the night awake and in great 
agony. Five minutes' application cured one side of the face, 
and a second five minutes' application cured the other, and 
then, to my surprise, she fell fast asleep in her chair. There 
has not been the slightest return of pain." 

III. Neuralgia of the Fifth Nerve. — Gr. E. The patient had 
been suffering for several years with neuralgia of the fifth 
nerve, of the most severe form. He had been subject to mala- 
rial fever, and, after a protracted siege of the same, was seized 
with neuralgia, which would recur at intervals. At these times 
he found it impossible to sleep. He became weak and nervous, 
and, when I saw him, his irritability was pitiful. The materia 
rnedica had been wellnigh exhausted in his treatment — opium 
and quinine being the chief medicines that he had taken. When 
he came under my charge, I made him discard all of these, and 
put him simply upon the Solution Hammondi 2 (the hospital 
mixture at the New York State Hospital for Diseases of the 
Nervous System). I applied the continuous current regularly 
every day for some three weeks, when I was gratified in seeing 
my patient so nearly well that I entirely discontinued treat- 
ment. His general health returned, and the use of the medi- 
cine was suspended. The neuralgia was confined chiefly to the 
supra-orbital branch of the fifth nerve, and to this nerve I ap- 
plied the current. 

IY. Dr. William Stephenson, of Edinburgh, 3 relates the fol- 
lowing case of sciatica : David O., aged fifty, a letter-carrier, has 
suffered from sciatica for four months, never had rheumatism, 

1 Medical Press and Circular, November 1, 1871, p. 384. 

2 ^ , — Strychnia sulph. gr. i. 

Ferri pyrophos. ) 
Quin. sulph. ) 

Syr. zingib. ) 

Acidi phos. dil. \ aa §1 J' 
Misce — 3 i. t. i. d. 

3 Medical Press. 



HYPERESTHESIA. 107 

but once lumbago. The pain extends over the whole length 
of the nerve, and affects also the superficial sacral nerves ; it 
is always worse at night, and greatly interferes with sleep. He 
has been blistered seven times, four times had acupuncture 
been applied, and he had taken several medicines. From the 
acupuncture he derived some benefit, but the pain always re- 
turned. 

The electricity (continuous current) was applied, and, bene- 
fiting from the experience of a former case, electro-puncture 
was tried at once. The relief, after the third application, was 
decided, but the returns of the pain after walking were at first 
severe and frequent, but never lasting long. Whatever pain 
he had was always at once removed by the application. In a 
fortnight he could walk about freely, but it was not till after 
five weeks' use that the last residue was removed, and he was 
able to resume his employment. 

Dr. Mierques (Lyon Medicate) applies, in gastralgia, a plate 
of zinc on the epigastrium, under which there is placed a piece 
of linen moistened with vinegar and water, and similar disks 
of copper between the shoulders. These are united by a con- 
ducting wire, and kept on by a bandage. These are useful, he 
says, in neuralgia, and cramps of the lower extremities, etc. 

V. Sciatica. — Mr. J. W. S. After constant exposure dur- 
ing the war, the patient contracted a low typhoid fever, which 
left him weak and emaciated for a long time. Since 1868 he 
has had twinges of pain down the back part of the leg, which 
have kept him in a perpetual state of misery, with only occa- 
sional intervals of several months, when he is free from pain. 
In winter his trouble is worse, and any exposure will immedi- 
ately produce a severe attack of neuralgic pain. Any indiscre- 
tion in his diet will also be followed by sciatica. He had gone 
through the usual siege of medication, including morphine, hy- 
podermics, and stimulating lotions. He came to me in July, 
when I made applications of galvanism to the nerve by the 
conical sponge-electrode, the sponge being held firmly over the 
obturator foramen. At the first visit his pain was excessive, 
but after fifteen minutes' application he left, feeling a sense of 
relief which he had not known for months. Two months and 
a half of this treatment were sufficient to dispel the pain, which 



108 CLINICAL ELECTRO-THERAPEUTICS. 

did not recur. Four months afterward, lie made a visit, when 
he stated that he had not had any return. 

^Rheumatism. — The use of electricity in this disease is at- 
tended with the following results : 

1. Diminution of pain. 

2. Absorption of exudation. 

Kheumatism is due to a retention of secretion dependent 
upon a cold or damp condition of the atmosphere. It finds a 
powerful remedy in electricity. By it, the contractile walls of 
the blood-vessels and lymphatics are stimulated, and the pent- 
up secretions are carried off. The faradic current has a re- 
markable anaesthetic effect in these cases. 

Dr. Holland, of Louisville, reports the following : 1 Mrs. M. 
C, aged sixty, had suffered about ten days from a rheumatic 
inflammation, with some exudation in the right wrist, render- 
ing the joint immovable ; there was one point upon the dorsal 
surface especially prominent, hard, and marked by excessive 
pain. The phalanges were semiflexed and stiff, probably from 
effusion around the tendons. Stimulating liniments and lo- 
tions, conjoined with regulated diet, had been used without 
making the faintest impression upon the disease. In one sit- 
ting the pain and tenderness were greatly relieved, and by local 
faradization of the muscles in the forearm almost entire free- 
dom of movement in the phalanges, with partial but very evi- 
dent benefit to the carpal mobility, was produced. The sittings 
were held on alternate days, and after the third, as none of the 
symptoms remained but a slight swelling, the case was dis- 
missed. She shook hands unconstrainedly with me, a few days 
since, and reported the joint as well. 

Anaesthesia. — Anaesthesia implies a full or partial loss of 
sensation dependent upon cerebral or spinal disease, or com- 
monly upon a derangement of the peripheral nerves. Anaes- 
thesia may be caused by disordered states of the blood, or hys- 
teria. Various mental causes will produce the disease, as will 
bodily fatigue. Sometimes the disease is due to central causes, 
when the loss of sensation is about the same. With anaesthe- 
sia there is a loss of tactile sensibility, " pricking," etc., and 
sometimes sensation is abolished entirely. According to Eu- 

1 American Practitioner, July, 1872. 



HYPERESTHESIA. 1 9 

lenberg, the different functions of the cutaneous nerves of sen- 
sation (touch, general sensibility of the skin, sensibility to pain) 
may be suspended singly or together, and paralysis of one 
function may occur with increased energy of others. Press- 
ure, sense of heat, and sense of locality, are paralyzed with the 
sense of touch partially or together. With anaesthesia there is 
disturbance of nutrition and circulation due to paralysis of the 
vaso-motor and trophic nerve-fibres. In making our diagnosis, 
we may use the aesthesiometer. In hysterical anaesthesia it 
is often impossible to give relief by electricity. The current 
should be the faradic, with the metallic plates or brousse elec- 
trique. Yery often the disease will occur with a loss of smell 
or disturbance of vision (amaurosis), nervous deafness, loss of 
taste, etc. These should be treated by the galvanic current 
after the several ways already enumerated. Anaesthesia of the 
fifth pair is a disease that is frequently met with. The phe- 
nomena occurring with the different varieties of the disease may 
be thus tabulated : 

When the ophthalmic branch j Anaesthesia of upper eyelid or forehead. 

is involved. \ Irritating substances entering the eye are not felt. 

When the superior maxillary j Anaesthesia of the skin of the upper part of the face, 
branch is involved. ( Teeth of the upper jaw are insensible. 

r Anaesthesia of skin of the lower part of the face. 
When the inferior maxillary J Increased flow of saliva, 
branch is involved. | Mastication difficult. 

I Teeth of the lower jaw insensible. 

The disease may be complete. The galvanic current of low 
tension to the nerve, and mild faradization of the skin, are 
recommended. 

Dr. Moos ' reports a case of nervous deafness he cured : 

" In the course of a developing series of nervous phenom- 
ena, there appeared first hyperesthesia of the auditory nerve, 
and subsequently complete deafness ; this, by means of a pro- 
longed treatment with the uninterrupted current, gradually 
disappeared." 

Asphyxia, /Suspended Animation, etc. 2 — Dunglison defines 

1 Heidelb. Bu., v., 82-84. 

2 For the history of numerous experiments with this agent, the reader is referred 
to an article by the author in the American Practitioner, October, 1872, p. 193. 



110 CLINICAL ELECTRO-THERAPEUTICS. 

asphyxia as " a state depending upon an insufficient aeration of 
the carbonized or venous blood. Owing to the supply of air 
being cut off, the unchanged venous blood of the pulmonary 
artery passes into the minute radicles of the pulmonary veins ; 
but, their peculiar excitability requiring arterial blood to excite 
them more or less, stagnation takes place in the pulmonary cap- 
illaries, and death occurs chiefly from this cause and from the 
want of arterial blood, and not owing to venous blood being 
distributed through the system and poisoning it, as was the 
idea of Bichat." 

The causes of asphyxia may be submersion in a medium 
unfit for respiration, or drowning ; pressure of the glottis, or 
strangulation ; paralysis, from traumatic causes, of the muscles 
of respiration ; and suffocation when air is denied the lungs, 
either by stoppage of the air- passages or the inspiration of poi- 
sonous gases ; or, finally, the asphyxia of new-born infants, or 
asphyxia neonatorum. 

The different ways productive of asphyxia, recited before, 
all cause the same symptoms to be manifested, and a general 
paralysis of the system ensues. The lungs are powerless to do 
their work, as they are filled with carbonic-acid gas, which can- 
not escape. Electricity exerts its restorative power by exciting 
nervous force. This may act secondarily by stimulating the 
paralyzed nerves and by emptying the minute blood-vessels, or 
it may act directly upon the heart and the vaso-motor nerves 
through the sympathetic, or immediately upon the nerves sup- 
plying the special muscles concerned in respiration (the phrenic 
and intercostals). It may expel the blood from the minute 
vessels of the cord, or diminish a congested condition of the 
cerebrum or cerebellum. 

Experiments made by Meyer demonstrate the fact that after 
the death of an animal, when the heart no longer beats, if a 
strong induced current is transmitted into this organ, its rhyth- 
mical contractions reappear. The contractions are much more 
manifest in the right portion of the heart than in the left, as 
generally after death the left ventricle is firmly contracted, and 
is not reached by the electric irritation, while the right ventri- 
cle in this condition is almost always filled with blood, and con- 
tracts powerfully under the influence of the electrical current. 



HYPERESTHESIA. Ill 

In animals that have been killed by chloroform the left ventricle 
sometimes continues to pulsate, though faintly, after the action 
of the right ventricle has ceased, in consequence of excessive 
expansion by means of the black blood. If in such cases we 
electrize the left ventricle, its pulsations begin again and the 
expansion lessens. The insensibility following the inhalation 
of carbonic-acid gas, as well as other noxious vapors, and other 
forms of asphyxia, are finally produced by coma. The use of 
galvanism should therefore be directed to the cerebral as well 
as pulmonary difficulty. 

There are certain conditions separate from asphyxia, result- 
ing in death. These are strictly cerebral as far as the primary 
lesion is concerned, and may be enumerated as concussion, 
congestion of the brain, and narcotic poisoning. Syncope is a 
morbid condition, in which electricity, as I have stated, may be 
advantageously used. In sunstroke the galvanic current has 
enabled me to save at least one patient, and I do not doubt its 
power to do good for others. 

In the consideration of poisoning by both narcotics and sed- 
atives we must realize the fact that narcotics produce death, 
beginning by coma and finally ending in asphyxia, and direct 
our treatment to both centres, the brain and respiratory or- 
gans ; and that sedatives produce death by syncope, and here 
direct our energies to the stimulation of the heart. In concus- 
sion, it is our idea to diminish the disturbance of the brain, and 
reestablish the normal circulation. 

In the production of respiratory movement, it has been found 
by M. Grondet 1 that the excitation of the diaphragm through 
the phrenic nerve is the most desirable way. To electrize this 
nerve we find the anterior border of the scalenus-anticus mus- 
cle by pulling the skin inward, with two fingers placed on the 
outer border of the sterno-cleido-mastoideus. Without discon- 
tinuing the action of the fingers, we separate them sufficiently 
to introduce between them a narrow moist conductor, which 
then presses directly on the phrenic nerve. After we have 
done the same thing to the other side we allow the induction 
apparatus to work rapidly and powerfully. The two phrenici 
in this way, equally excited, immediately cause strong heavings 

1 Magendie, Journal de Physiologic 



112 CLINICAL ELECTRO-THERAPEUTICS. 

of the chest, with a rushing of air into the lungs. We may at 
the same time electrize the intercostals and other muscles used 
in respiration. 

It is necessary to understand the process of fatal chloroform 
narcosis before we can fully consider the treatment. " When 
the impregnation of the blood takes place with moderate ra- 
pidity, the sympathetic system is the ultimum moriens, and 
death begins at the lungs. When, on the contrary, the circu- 
lation becomes very rapidly charged with a large proportion of 
chloroform, the narcotic effect may fall with such force upon 
the sympathetic nerves as to extinguish their vitality at once." ' 
Of course it is almost impossible to attempt a resuscitation in 
the latter case, as a complete paralysis of the heart invariably 
ensues. In the former we must apply the current to the phre- 
nic, as we do in the other forms of asphyxia. 

A case of opium-poisoning is reported by Dr. S. S. Page 
in the American Journal of Medical Science for April, 1843, 
page 301, where the patient took an enormous dose of pow- 
dered opium in mistake for cubebs. The stomach was evacu- 
ated and revulsive means employed, but the patient remained 
completely insensible. An electro - magnetic apparatus was 
used, one pole being placed over the heart, the other over a 
corresponding point on the right side. The patient opened his 
eyes, groaned, and moved his arms. After the fourth shock he 
moved his arms, and did not become insensible again. 

A case is related by Mr. Corfe in the Zancet, January 27, 
1844. A man had taken an ounce and a half of laudanum, 
and appeared to be quite dead. After the stomach-pump and 
external irritants had been -used in vain, recourse was had to 
the Leyden jar. The patient recovered. 

At a meeting of the Manchester Medical Society, Dr. Har- 
die recounted two cases of chloroform asphyxia in which, after 
the failure of ordinary means of resuscitation, such as cold af- 
fusions, artificial respiration, galvanism of the chest, etc., the 
recovery was effected by Ziemssen's method of pressing both 
poles of the battery deeply in at the root of the neck, one 
over each phrenic nerve. This caused a gasping, inspiratory 
movement, when the battery was temporarily removed and 

1 " Stimulants and Narcotics," p. 328. 



HYPERESTHESIA. 113 

the chest walls compressed ; and so on alternately until resto- 
ration. 

Friedberg's case of asphyxia by chloroform is reported as 
follows : " A patient, four years old, was put under the .influ- 
ence of chloroform for the removal of an encysted tumor of 
the left lower eyelid, when suddenly a short, rattling inspira- 
tion ensued, after which breathing ceased. For several minutes 
the patient was rubbed ; artificial respiration was also tried, but 
was ineffectual. Friedberg then faradized the diaphragm by 
placing one of the electrodes of Du Bois-Reymond upon the 
phrenic nerve, and applying the other to the lateral wall of 
the thorax in the seventh intercostal space, pressing it deeply 
against the diaphragm. This faradization was made alternately 
on the right and left side, the circuit remaining closed each time 
for the duration of a deep inspiration. After the current had 
thus been applied and interrupted ten times, the first weak but 
plainly spontaneous inspiration occurred, which was soon fol- 
lowed by a second and third, the face reddening and the radial 
pulse becoming perceptible. After persistence in this treat- 
ment, the patient fully recovered in twenty minutes, and the 
operation went on. 

In the asphyxia of new-born children, or asphyxia neona- 
torum, electricity has occasionally been called in ; but, as it has 
been more used by midwives, or German hebammes, than by 
medical men, the literature of electro-therapeutics contains 
very little information in regard to the subject. I learn that 
Dr. Alexander Murray, of New York, has saved three lives of 
asphyxiated children by the method I will presently recite. 
He tried faradization of the phrenic nerve in one case, and 
this child instantly died. The great idea in treatment is to 
pass the current along the course of nerves and their ramifica- 
tion, the object being to restore the circulation of the blood 
and respiration by transmitting the current through the pneu- 
mogastric. The child should be placed in a firm position, with 
the head elevated so as to clear the mouth and fauces of 
mucus. The body should be kept warm (about 99° Fahr.), 
and the strong faradic current used, one pole applied to the 
nipple, the other over the seventh intercostal space, moving 
the latter in a circular manner toward and over the precordial 
8 



114 CLINICAL ELECTRO-THERAPEUTICS. 

region. The electrodes should be sponge-covered and well 
moistened. 

. The results arrived at from my own practice and experi- 
ments are the following : 

1. That it is useless to expect good results if five minutes 
have elapsed since life appeared extinct. 

2. That the current should be applied faithfully and steadily ', 
one pole being placed on the ensiform cartilage, the other on 
the base of the skull or over the tracks of the great nerves of 
the neck. 

3. That the faradic and interrupted galvanic currents are 
the best. 

4. That the current should be applied some time after re- 
spiratory movements have become regular. 

ELECTRICITY AS A GENERAL CUTANEOUS STIMULANT. 

We cannot speak too highly of electricity as a remedy, par- 
ticularly in those cases of extreme prostration associated with 
anaemia and chlorosis, when the nutritive functions are dis- 
turbed, and assimilation of food is imperfect. The vast num- 
ber of important morbid conditions, though sometimes of little 
moment to the physician on account of the slight evidence of 
symptoms, are all capable of being benefited by electricity. 
Hysteria, nervous asthenia, where cold hands and feet and a 
phosphatic condition of the urine are present, spinal conges- 
tion, and spinal irritation, are included in this list. The fara- 
dic current, applied by means of large sponges to the surface, 
on the plan proposed by Drs. Beard and Rockwell, produces a 
lasting stimulation of the skin which has decided advantages 
over rubbing, cold-water baths, and other means generally em- 
ployed. Of course the application of faradism in this way is 
not within the province of the occupied physician, but should 
be performed by a nurse or friend of the patient. An excel- 
lent application, in cases of spinal irritation, is to the vertebral 
column. The faradic current is the one to be used. Faradism 
may be used to overcome insomnia. 



CHAPTER X. 



CONVULSIVE DISEASES. 



Chorea. — Scrivener's Palsy. — Paralysis Agitans. — Epilepsy. — Tetanus. — Asthma. — 
Torticollis. — Diseases of Women. — Intra-Uterine Galvanic Pessary, etc. — Elec- 
tricity in Obstetrics. — Diseases of the Eye. — Constipation and Intestinal Ob- 
struction. — Skin-Diseases. 

Chorea. — Notwithstanding the fact that Golding Bird and 
others have had such brilliant success with electricity, I must 
say that the conclusions of these gentlemen have not been veri- 
fied by the several cases I have seen treated, or have treated 
myself. Electricity, except as a tonic in this disease, has been 
without virtue in my hands. Meyer recommends that the in- 
termittent galvanic current be applied to the suffering limbs. 
Ullsberger, whose prize thesis I recently translated, and which 
appeared in the Americ/in Journal of Obstetrics, 1 recommends 
it quite highly. Galvanization of the sympathetic may be re- 
sorted to with faradization of the convulsed parts. Ullsberger 
cites several cases, among which are these : 

Maurice Benedikt treated, among others, the daughter of a 
cotter, aged nine years, suffering from tonic spasms, by direct- 
ing the galvanic current on the ganglia and mastoid process, 
continuing the seances two weeks and a half. The cure was per- 
fect. He effected several other cures of idiopathic chorea. For 
example : a scholar, aged twelve years ; a girl, the same age ; 
the son of a laborer, aged twelve years ; and a boy, aged eight 
years, suffering from general chorea minor. It required two 
months for the cure of this last case, which lasted only a year, 
at the end of which time a relapse occurred, from which, never- 

1 American Journal of Obstetrics, May and August, 1872. 



116 CLINICAL ELECTRO-THERAPEUTICS. 

theless, lie was radically restored. The son of a shoemaker, 
nine years old, being affected with choretic movements of the 
ocnlar and labial nmscles, was cured by the same treatment in 
eight weeks. A girl of twelve years of age had suffered with 
infantile eclampsia when she was but nine months old ; later, 
from unilateral chorea. A galvanic application ameliorated her 
condition. A boy, aged twelve years, who had suffered from 
taenia, was completely relieved, and like success attended a girl 
of the same age. A boy, aged fourteen, having submitted to 
the faradic treatment for two months and a half, experienced 
such a favorable result that he continued exempt from further 
attacks, and his general health gained appreciably. Giovanni 
Finco reports the following case : A girl, aged twelve, had suf- 
fered a series of nervous symptoms, such as neuralgia of the 
superior cervical nerves, accompanied with sharp pains in the 
epigastrium, or nypersesthesia of the left side of the neck, and 
of the thorax. These symptoms were complicated afterward 
with dysphonia and involuntary movement of the neck and 
arms. They were repeated every day, commencing at half-past 
ten in the morning, and lasting till nine at night ; finally end- 
ing in gaping, great prostration, and pallor. All remedies used 
for a year and a half were unsuccessful, but the induced cur- 
rent produced visible improvement. Therefore it was in future 
used. The positive pole was put in one hand, and the negative 
pole was placed on the nape of the neck, the scapula, and the 
left side of the breast. After five seances, an amelioration was 
perceived ; after two months, a notable improvement. At last, 
after a continuation of some weeks, not only had the cure be- 
come perfect, but the whole physical constitution of the patient 
had undergone a very advantageous change. Yon Holtzbeck 
has enriched the records of electro-therapeutics by three cases 
of little girls aged seven and a half, ten and a half, and eleven 
years. 

Chorea is met with most frequently in the female sex be- 
tween the ages of five and nine. This statistical fact was given 
to us by H. M. Hughes and E. Burton Brown. Of fourteen 
patients attacked with chorea, five were cured, one improved, 
three remained unsuccessfully treated, and in five the result 
was not noted. The daughter of a servant, nine years of age, 



CONVULSIVE DISEASES. 117 

emaciated and weak, suffering from St. Vitus's dance, was treat- 
ed by Kudolphe Wecke. He subjected her to electric treat- 
ment, accompanied by tepid baths and cold spongings, by 
which the child became strong and thriving. 

Scrivener's Palsy (Writer's Spasm, Impaired Writing- 
Power, etc.). — This disease is comparatively so rare that elec- 
tricity has not been fully tested. It has been my good fortune 
to meet with a case or two, one of them quite aggravated. Both 
were relieved, and one cured, by the application of the two 
currents. The disease has been pronounced by Mr. Solly * to 
be due to a disintegration of the " vesicular neurine " in the 
upper part of the cord. "With this affection there is little loss 
of sensation, but always a loss of muscular power, and an atony 
of the flexors of the forearm, rendering it impossible to keep 
the point of the pen or pencil in contact with the paper. 
There is a spasmodic contraction of some of the muscles of the 
hand and forearm, and the hand is convulsively drawn from 
the paper by a choreic movement increased by the exercise of 
the will. A galvanic current is the most beneficial, and the 
electrodes should be so small as to include but one muscle at a 
time in the circuit. The current must be mild, or it will only 
aggravate the disease. "With this application to special mus^ 
cles, one pole may be placed at the nape of the neck and the 
other to the muscles of the hand and forearm. 

I. James McC, aged thirty-eight. The patient had followed 
the occupation of clerk for many years, and had assiduously 
worked at his desk for many hours in the day. Two weeks be- 
fore I saw him he noticed an impairment in his writing-power, 
and this consisted in an inability to write without the occur- 
rence of a convulsive contraction of the extensors of his right 
forearm, by which the pen flew from the paper. This did not 
occur at the moment of writing, but after a few words had been 
written. He attempted to keep the hand steady by the influ- 
ence of the will, but all his efforts were ineffectual. "When 
he attempted to hold the point of any small object, such as a 
stick or pencil, against the surface, the same spasm would 
occur. There was no wasting of the muscles, pain, or other 
symptoms. I determined to try galvanism, combined with 

1 " Surgical Experiences," p. 205, London, 1865. 



118 CLINICAL ELECTRO-THERAPEUTICS. 

manual exercise and the internal administration of strychnia 
in doses of -^ of a grain. Galvanism of the flexors of the fore- 
arm and of the small muscles of the hand was made, and, at 
the same time, the positive pole was held for a few minutes at 
the nape of the neck. He was directed to procure the round 
of a chair with which to exercise. Galvanization was persevered 
in, although the progress was very slow. At first he could not 
write more than two words (almost illegibly) ; but, as he grew 
better, these spasms disappeared. Three seances a week, kept 
up for a period of about three months, effected such an improved 
condition that he was finally discharged at the end of that time. 

II. " C. D., 1 aged forty-five, applied to me in March, 1872, on 
account of want of power in his right hand. About two months 
before he had noticed that his writing became very bad, from 
the ring and little finger failing to give proper support to his 
hand as it held the pen. This difficulty increased, and was 
soon accompanied by inability to hold the pen firmly between 
the thumb and first two fingers. To obviate this, he would 
use a short pencil, the end of which was planted in the palm, 
while its axis was grasped by all the fingers, and he wrote 
without leaning upon the two inner ones, but sometimes used 
the extremity of the ulna as a support. He could not cut a 
pencil in the ordinary way, nor could he snap the index or 
middle finger against the thumb. 

" For some years past he has had much brain-fag, and early 
in last winter he broke down in health so much that he obtained 
medical treatment, under which he had greatly improved. He 
suffered from pain at various times, sometimes seated near the 
scapula, at others in the hand and forearm. With the act of 
writing he had pains in all the muscles of the arm, and an un- 
easiness of mind. The hand was wasted, and there was atro- 
phy of those muscles supplied by the ulnar nerve — notably to 
the dorsal interossei. There was also falling away of the plump 
of the thumb ; there was considerable loss of power in the fin- 
gers, and none of them could be moved in a lateral direction. 
There was no definite loss of cutaneous sensibility in the hand ; 
flexion was perfect, but extension imperfect, especially in the 
third and fourth. 

1 Reported by Dr. Buzzard in a recent number of the London Practitioner. 



CONVULSIVE DISEASES. 119 

" There was no response to the induced current of any of 
the muscles of the little finger, in the interossei, the adductor 
pollicis, nor the flexor carpi ulnaris. With the constant cur- 
rent (thirty-eight cells) there were brisk contractions of the in- 
terossei when labile application was made. Before the diffi- 
culty began, there was great pressure made on the upper part 
of this arm by the tight sleeve of a coat he had worn for some 
time previously. 

" The patient was treated by the constant current. The 
seances were of an hour's duration, and there were three of 
them in a week. The positive pole was placed upon the mid- 
cervical region, and the negative with the hand in water for a 
few minutes, ten cells being employed ; at other times the posi- 
tive pole was applied to the elbow where the ulnar nerve is 
superficial. On March 30th, faradism gave contraction, and 
was substituted. By May 17th, muscular power had greatly 
returned, and the atrophy had diminished. By the end of 
June the patient was apparently well, and by July 11, 1872, 
all treatment was suspended." 

Paralysis Agitans. — Galvanism of the spine may be fol- 
lowed by good results in this affection, but the treatment is 
tedious. Recent cases are only those that there is any hope 
for. Althaus relates a successful case, as does Dr. Russel Rey- 
nolds. In the latter, Dr. Reynolds used Pulvermacher's chain, 
and, after six applications, the patient recovered. 

Epilepsy. — The mystery that surrounds the etiology of epi- 
lepsy leaves us very much in the dark as to what effect the 
electric current would have. As a general thing, the applica- 
tion of electricity has not been followed by any appreciable 
results. In some cases galvanism has given relief. Althaus 
recommends that the negative pole be applied to that point 
from which the aura starts, if it be a mucous membrane. If 
the aura starts from the epigastrium, the positive pole should 
be applied there. Dr. Hammond recommends the passage of 
the current through the cranium, and also the sympathetic. 
When the current is directed through the head, one-third of 
the time it should be passed antero-posteriorly, one pole being 
placed on the back of the neck, and the other on the forehead ; 
for another third, one pole is placed on each mastoid process ; 



120 CLINICAL ELECTRO-THERAPEUTICS. 

and for the other, one on the sympathetic nerve in the neck, 
and the other on the spinal column, at about the first dorsal 
vertebra. Ten or fifteen cups should be used. The above 
treatment has been in vogue at the New York State Hospital 
for Diseases of the Nervous System. As other remedies were 
used at the same time, it is impossible to definitely state really 
how much good galvanism did. Up to April 20, 1871, Dr. 
Hammond had treated, out of two hundred and six cases, one 
hundred and thirty in this way, and of these fifty-nine were 
entirely cured. Cases which I have seen myself, who before the 
time of treatment were attacked several times in the day, were 
notably relieved. The cerebral symptoms and general weak- 
ness were improved, and the number of seizures diminished. 

There are other diseases of a spasmodic nature which are 
amenable to electrization, and these may be enumerated as tor- 
ticollis, asthma, and tetanus. In the first, the sterno-cleido- 
mastoid and trapezius muscles are thrown into a state of con- 
traction, through a diseased condition of the spinal accessory 
nerve. A galvanic current of high tension applied to the af- 
fected muscle, and the faradic current to the antagonistic mus- 
cle, will remove this condition, though very slowly. 1 Galvani- 
zation of the vagus will greatly relieve true spasmodic asthma. 

Asthma Nervosum? — A patient thirty years old was first 
attacked, when twenty-two years of age, with long-continued fits 
of sneezing, lasting a few hours daily, and returning periodi- 
cally, which suddenly gave place, after one and a half year, to 
attacks of asthma. The attacks, which were very violent, ap- 
peared at first spontaneous ; afterward, in consequence of very 
slight exertion, causing the patient great distress, notwithstand- 
ing all attempts for relief. In the spring of 1866 he consulted 
Caspari, who found slight emphysema, costal respiration, draw- 
ing in of the epigastrium during deep inspiration. During the 
attacks the diaphragm was very low down, and took no part in 
respiration, which was mainly costal. The galvanic treatment 
consisted in fixing the negative pole (diameter eight centime- 
tres) to the sacrum, while passing the positive pole along the 

1 Not more than five cells should be used at first. 

2 Reported by Dr. A. Caspari (Beitrag zum Electro-therapeutischen Wiener Wochen- 
"6te«,:Nos. 21, 22, 1868, casuistik). 



CONVULSIVE DISEASES. 121 

spine from the neck to the lumbar region. Length of each ap- 
plication, ten to twenty minutes, thrice, once a week. Marked 
improvement after five sittings. After twenty-five sittings, the 
attacks disappeared, and all movements of the body were pos- 
sible without creating any disturbance. The patient remained 
entirely well until the middle of September, 1866, when slight 
attacks recurred, which were suppressed by fourteen sittings. 
Since then no recurrence. 

Tetanus. — Notwithstanding the fact that galvanization of 
the cord produces spasms in the muscles receiving their ner- 
vous supply from the part irritated, Matteucci and .Nobili found 
that, when frogs were tetanized with strychnia, a strong gal- 
vanic current passed through the cord would restore a normal 
condition. Dr. Mendel, of Berlin, has treated a case of this 
disease successfully, and has reported it in the Berliner Kli- 
nisehe Wbchenschrift, September 21, 1868. Dr. Mendel's first 
case was of a child aged four years. The child was run over 
by a wagon on May 17, 1868, and the thumb was crushed. On 
the 31st of May, trismus set in. Contraction of muscles of 
neck. No effect from opium. On June 12th, slight fever, head 
drawn backward, cyanosis of the face, trismus well marked. 
Strong contractions of the muscles of the right arm and fore- 
a'rm, which cannot be controlled by manual force. Muscles of 
back in tetanic rigidity. Muscles of thigh moderately, muscles 
of calf strongly contracted. Increased reflex irritability. Ca- 
tarrh of the right lung. 

Galvanic treatment : Eight elements, anode to the outer sur- 
face of the right forearm, cathode applied over the cervical 
vertebrae ; immediately upon completion of the circuit, it was 
possible to move the hitherto rigid hand in all directions. A 
similar application was made to the lower extremities, the 
anode being placed directly on the muscles of the calf, which 
was not followed by benefit ; the anode, however, being placed 
on the anterior surface of the leg, immediately under the joint, 
all rigidity of the calf disappeared ; similar in both extremi- 
ties. The trismus could not be relieved. By application of 
the electrodes to the side of the muscles of the neck, the rigid- 
ity of these, as of some of the muscles of the back, was dimin- 
ished. 



122 CLINICAL ELECTRO-THERAPEUTICS. 

Examination on June 13th revealed an improved suppleness 
of the muscles. The induced current tried experimentally 
caused an aggravation of symptoms ; the constant current 
caused relaxation. 

June 14:th. — Defervescence ; only slight tension in a few 
muscles. After two more sittings there is, on June 18th, only 
slight contractions of the fingers of the right hand ; no more 
signs of tetanus — followed by complete recovery. 

III. Idiopathic Tetanus in a Girl Eleven Years old — Cure 
in Ten Days by Application of the Constant Current. — Com- 
mencement of disease on June 15th, with trismus. On June 
17th, contraction of muscles of neck and calf, followed by gen- 
eral tetanus, with greatly-exaggerated reflex irritability. High 
fever ; temperature 104°. In this case, also, eight to twelve 
elements were employed, the relaxation continuing some time 
after cessation of the current. After two sittings, marked im- 
provement followed, recti-abductor muscles being tense ; their 
relaxation was accomplished by the application of the anode to 
the second lumbar vertebra, and the cathode to the sternum. 

June 23d. — The intervals between the attacks lengthened, 
and the attacks shortened. Temperature 102°. During the 
following days, patient continued to improve, with galvaniza- 
tion ten to fifteen minutes in duration. 

June 29th. — Temperature normal ; no more tetanic rigidity, 
and only slight tension of the masseters. Cure. 

The author draws the following deductions : Treatment 
must be directed against every separate group of muscles af- 
fected. The effect follows by the influence of the current on 
the sensitive nerves. It is remarkable that relaxation followed 
most easily when the anode was placed on the antagonists of 
the tetanic muscles. The strength of the current must not be 
too great — six to ten elements ; a few more in adults. 

The direction of the current seems to have no influence on 
the effect. The induced current has no influence on the tonic 
contraction of the muscles. 

DISEASES OF WOMEN. 

The gynaecologists who have given prominence to electricity 
have adopted it as a very important mode of treatment in this 



CONVULSIVE DISEASES. 



123 



large class of diseases. Golding Bird l lias used static electri- 
city, with the result of twenty cures out of twenty-four cases of 
amenorrhoea. Dr. A. D. Rockwell, of New York, has been 
remarkably successful with the cases he has treated by faradi- 
zation. 

I have already dwelt upon the modus operandi for faradiza- 
tion of the uterus, and the exigencies of the individual case 
must determine the plan of treatment. In all conditions of 
displacement, whether from laxity of the suspensory ligaments, 
or increased weight of the organ from engorgement, we may 
employ faradization. The different versions or flexions of the 
organ, when due to want of tone of the ligaments, are also re- 
lieved by the induced current. In metrorrhagia and monor- 
rhagia, uterine contractions excited by means of this current 
will stop the haemorrhage. In metritis, faradization will pro- 
duce good results not obtainable at times by other treatment. 

Sir J. Y. Simpson, of Edinburgh, and Drs. T. G-. Thomas, 
Koeggerath, and Murray, of this city, have each been successful 





Fig. 44.— Intba-Utebine Galvanic Pesbabies. 

1. Sir J. T. Simpson's. 3. Dr Thomas's. 

2. Dr. Noeggerath's. 4. Dr. Thomas's improved. 

5 and 6. Dr. Murray's. 



in certain uterine diseases with a little instrument known as the 
" intra-uterine galvanic pessary. 5 '" These are made of beads or 
disks of two opposite electric elements strung on a central sup- 
port terminating in a bulb, which keeps them in place in the 
uterine cavity. Dr. Thomas has had many cases of amenor- 

1 Quoted by Althaus, p. 625. 



124 CLINICAL ELECTRO-THERAPEUTICS. 

rhcea and dysmenorrhea that have been cured in this way. It 
is a valuable instrument for increasing the size of an undevel- 
oped or dwarfed uterus. 

Dr. Fordyce Barker and others have used Garrat's disks in 
many uterine disorders. They have been particularly success- 
ful where a mild counter-irritant was required. 

ELECTRICITY IN OBSTETRICS. 

When we consider that the uterus is a muscular organ, and. 
that, like all other organs containing muscular tissue, it will 
contract when stimulated by electricity, we must arrive at the 
conclusion that, in an atonic condition, we may readily make it 
eject its contents by the application of a faradic current. This 
fact, though doubted by Scanzoni and the late Sir J. Y. Simp- 
son, has been proved by others, among them Drs. Radford and 
Barnes. 

Electricity is recommended in tedious labor, hemorrhage, 
or for bringing on uterine contractions in special conditions 
when they are desired. We may apply one pole over the lum- 
bar vertebrae, and the other to the cervix ; or, as recommended 
by Dr. Barnes, both sponges to the abdominal parietes. The 
current must be mild, otherwise there is great danger of pro- 
ducing the death of the child, or convulsions and other bad 
symptoms upon the mother. We may claim, as the advantages 
of its use — 1. The contractions are more energetic than those 
produced by ergot. 2. Its action is immediate. 3. It can be 
used when swallowing is impaired, and the patient cannot take 
ergot. 4. The contractions are regular and normal. 

Diseases of the Eye. — In cases of amaurosis, Xhe tain elec- 
trique may be employed with success. For weakness of sight, 
and photophobia, we can also use the galvanic current. There 
are various changes in the cornea that may be influenced by 
electricity. Slight opacity may be removed in a very short time 
by the galvanic current, but a total opacity of that part of the 
eye requires more patience. Electricity may be applied to the 
closed eyelids by a sponge, or locally by smooth metallic con- 
ductors. Not more than from two to five cells should be used. 
Dr. Noyes, of New York, reports a very interesting case of 



CONVULSIVE DISEASES. 125 

structural change of the eyeball, dependent upon a paralysis 
of the fifth cranial nerve. 

The following case is one of paralysis of the upper two 
branches of the fifth nerve, and only partial affection of the 
third or submaxillary division. It has a special interest be- 
cause of the striking benefit which has been derived from the 
galvanic current : * 

Amelia McC, aged seventeen, came to the New York Eye 
and Ear Infirmary October 14, 1870. The right eye had for 
five days been inflamed, and while there was moderately in- 
tense injection of the conjunctival and scleral vessels and the 
whole cornea was ulcerated, there was no expression of pain 
nor intolerance of light ; I at once, from this passive behavior, 
suspected the fifth nerve to be at fault, and found such to be 
the fact. I could put my finger on the cornea and the conjunc- 
tiva without causing the patient to shrink. She had an erup- 
tion on the skin of the right half of the forehead and the side 
of the nose, as parts supplied by branches of the ophthalmic 
nerve : this continued for a few weeks, and disappeared. On 
inquiry, I learned that in August preceding a numbness had 
befallen this side of the face and head after she had suffered 
from a severe headache — an attack much worse than any she 
had had before. * There had been no other special symptoms, 
and the matter was considered unimportant. The inflamma- 
tion of the eye came on spontaneously. I carefully examined 
the region of insensibility, and found it was terminated accu- 
rately by the median line of the face in front, that it included 
the upper lip, side of the nose, eyeball and lids, forehead and 
scalp nearly to the vertex, temple, and anterior two-thirds of 
the cheek. The chin, the cheek in front of the ear, and the 
auricle and neck, had sensibility, though in slightly-diminished 
degree. The left side of the face was perfectly natural. There 
was loss of sensibility on the right half of the tongue, the up- 
per lip and gum and inside of the cheek, and the anterior pillar 
of the fauces. Sense of taste she did not perceive to be im- 
paired. The right nostril could be tickled with impunity, and 
a Eustachian catheter did not excite resistance until it arrived 
at the soft palate. Contraction of the palatine muscles was 

1 Reported by Dr. Noyes, New York Medical Journal, August, 1871. 



126 CLINICAL ELECTRO-THERAPEUTICS. 

normal, and the masseter on the right side seemed as vigorous 
as on the left. 

The nature of the corneal inflammation being clearly indi- 
cated, I determined to try the benefit of the galvanic battery, 
and sent the girl to Dr. G-uleke, who kindly consented to con- 
duct this part of the treatment. I directed, in addition, the 
use of sulphate of atropia, of hot fomentations, and occlusion 
of the eye by a bandage. 

The surface of the cornea was entirely stripped of epitheli- 
um to its margin, although its deeper tissue was almost trans- 
parent ; iris and pupil could be distinctly seen. After three 
applications of the constant current, I was surprised at the im- 
provement in the cornea. Although the inflammatory redness 
continued about the same, the epithelium had been regenerated 
all around its rim, making a circle at least one-tenth of an inch 
wide, and leaving a central bared portion about two lines across. 
During the following week the growth of epithelium continued, 
but less rapidly, and the injection of the eyeball diminished. 
The sensibility of the cheek improved, the posterior limit of 
the numb region coming a little forward. After this time the 
keratitis grew worse, the central ulcer widened, and the tissue 
of the cornea became infiltrated with pus. There were two 
small ulcers in the cornea. At the fifth week of the disease, 
the patient's condition was very bad ; from that time improve- 
ment was rapid. Perforation of the cornea did not take place. 

Subsequent progress : By January 1st the cornea was near- 
ly all covered with whitish, thick epithelium containing blood- 
vessels. The opacity of the cornea grew less. There was no 
marked loss of tension of the globe. While the eye improved, 
the sensibility of the face equally increased. The dividing line 
between the numb and sensitive region ran from the middle of 
the zygoma to the angle of the mouth — this advanced farther 
upon the malar bone, so as to come within half an inch of the 
outer palpebral commissure — but the side of the nose and up- 
per lip remained insensible. The forehead also recovered down 
to the eyebrow, but the lids and conjunctiva are anaesthetic. It 
must be noted that the patient is always aware when firm press- 
ure is made, although so indifferent to pain that she once blis- 
tered the cheek by applying scalding water, and did not know 



CONVULSIVE DISEASES. 127 

it. In examining the right ear I found the membrana tympani 
opaque, its epidermoid layer thickened, and the appearances 
such as belong to subacute otitis media. Watch heard only 
when it touched the auricle. The membrana tympani could 
be touched more roughly than the normal drum membrane, 
although it had sensibility. The meatus auditorius showed a 
diminished though moderate degree of sensation in all parts, 
except on a spot about the middle of the anterior wall, nearly 
half an inch in length, which was entirely devoid of sensation. 
I was struck by this circumstance, and tested the fact several 
times to be sure of it. I am at a loss to give any anatomical 
explanation for it. The impaired hearing is evidently due to 
catarrhal inflammation of the middle ear. 

The treatment by galvanization has been steadily kept up 
by Dr. Guleke, who has supplied the subjoined notes : 

" Examination by the constant current shows loss of feel- 
ing on the right side in the first and second branches of the 
fifth nerve. The third branch does not show quite so much 
reaction as on the left side. Contraction of the muscles of the 
affected region is found weak on reversing the current, and 
most so around the eye and angle of the mouth. The inter- 
rupted current gives contraction of the muscles of the right 
side in the same degree as on the left. 

" Application. — The positive pole applied to the ganglion 
superioris of the sympathetic on the right side of the neck ; the 
negative pole near the eye, or on the forehead or cheek. The 
positive pole was changed to the spinous processes of the upper 
vertebrae, when the place over the ganglion was too much irri- 
tated. The strength of the current was from four pairs of cells 
to six pairs in the later period of treatment. The first three 
or four months the electricity was daily used, later the patient 
came about every other day. The length of each application 
was from three to four minutes." 

Dr. Areola, of Palermo, has already employed this remedy 
with success in granulations of the conjunctiva ; and Dr. Kohn, 
of Berlin, obtained successful results in seventeen cases. 1 The 
negative pole of the battery is applied, by means of a buttoned 
sound, to the inverted surface of the upper lid and conjunctiva. 

1 "Elements d'electro therapie oculaire," in Gazetta Clinica di Palermo, 1870. 



128 CLINICAL ELECTRO-THERAPEUTICS. 

The positive pole is applied to the nuchse by a sponge satu- 
rated with salt-water. The first session is of ten minutes' du- 
ration. Dr. Schivardi publishes three cases of old granulations 
lasting respectively, in duration, two, three, and eight years. 
The first case was cured in five sessions ; the second was de- 
cidedly improved in two sessions ; the third, affected also with 
concomitant blepharitis and pannus, not only recovered from 
these affections, but also regained sight in nine sessions. To 
practise electrization three assistants are required ; one to hold 
the positive pole, the other the negative, the third holds the lid 
reversed and the head fixed. 

Constipation. — When the contents of the rectum accumu- 
late on account of an atonic state of the muscular tissue of that 
gut, it is extremely difficult to find a remedy that will remove 
the obstruction without eventually increasing the atony by re- 
action. In some cases the presence of diarrhoea may forbid the 
use of laxative medicines ; electricity is then indicated. When 
peristaltic motion is diminished, we may use the currents as di- 
rected in another chapter. 

Prof. Benedikt recommends the use of the primary in- 
duced current in constipation ; one electrode to be placed in 
the lumbar region, the other at numerous points on the ab- 
dominal wall. The abdominal pole must be pushed hard down 
upon the abdominal wall, and a very strong current be used. 
Prof. Benedikt thinks the treatment is of especial value in cases 
of obstinate chronic constipation in which there is a tendency 
to hypochondriasis. He relates the case of an officer who had 
been severely wounded eight months before coming under 
treatment, during which time he had not had a stool save by 
the use of medicines, but in whom the electrical excitation 
always produced a natural evacuation. Three weeks of daily 
treatment served to cure the case. 1 Prof. Benedikt states that, 
in numerous cases of constipation occurring in spinal and cere- 
bral disease, he has derived great benefit from the method de- 
scribed. 

Althaus also recommends it in tympanites and flatulency. 
Fardization of the rectum is the most available way to remove 
those accumulations of gas. 

1 Wiener Medical Presse, No. 37, 1867. 



TREATMENT OF SKIN-DISEASES BY ELECTRICITY. 129 

Dr. M. Macario 1 reports a case of obstinate constipation in 
a man seventy-one years old, which was successfully treated by 
the induction-current. A metallic electrode was introduced 
into the rectum, and the other passed over the transverse colon. 
By application of a strong current during ten minutes, the ab- 
dominal muscles contracted energetically, and acted " like the 
troubled sea." Patient complained of severe pain. Immedi- 
ately after discontinuance, improvement followed ; cessation of 
stercoraceous vomiting. In four hours evacuations were free. 

Intestinal Obstruction. — Dr. Lowy 2 relates the case of a 
boy, aged nineteen, who was affected with typhoid fever in 
July, 1870, followed by ulceration of the intestines and general 
peritonitis. The symptoms of hiccough, nausea, vomiting of 
green matter, and collapse, ensued. Lowy introduced into the 
rectum a sound connected with Du Bois-Reymond's apparatus, 
and placed the other pole over the location of the pylorus. 
The current was applied for fifteen minutes. "When it was 
remitted, the patient vomited stercoraceous matter containing 
grape-seeds. The battery was again applied in the evening, 
and more fluid was vomited. In a few days another strorg 
current was applied, and a stool containing a hard body, the 
size of a hen's-egg, came away. This body was composed ex- 
clusively of grape skins and seeds. The boy gradually recov- 
ered his health. 



THE TREATMENT OF SKIN-DISEASES BY ELECTRICITY. 

It is the general opinion of dermatologists nowadays, I 
believe, that skin-diseases are simply neuroses. Neumann, 
Barensprung, and others, unite in this conclusion. Numerous 
experiments substantiate the truth of this assertion, and have 
proved that nearly all skin-diseases are amenable to electricity. 
Cazenave and Romberg consider prurigo a nervous disease. It 
is incontrovertible that urticaria and other diseases character- 
ized by nervous irritation are but morbid states of the ultimate 
cutaneous nerves. The consideration of the fact that the vaso- 
motor system of nerves is directly influenced by the sympa- 

1 Annali universi di medicale, October, 18*70. 

2 Wiener Medical Presse, No. 37, 1867. 

9 



130 CLINICAL ELECTRO-THERAPEUTICS. 

thetic, will, enable us to understand why galvanization of this 
trunk will eventually influence the nerves supplying the minute 
vessels of the skin. 1 

Purely local diseases may be treated by galvanization or 
faradization of the skin itself. 

Dr. E. L. Mann, 2 of Brooklyn, has contributed to the Medi- 
cal Record a most valuable article upon the treatment of skin- 
diseases. He presents a number of reliable cases, some com- 
plicated with other affections, in which galvanization of the 
sympathetic was followed by a rapid cure. I extract the fol- 
lowing case from Dr. Mann's article : 

I. " Miss O'C. Eczema following intermittent fever. Has 
had four succeeding attacks, which reduced her health, render- 
ing her weak and anaemic. A short time after the last attack 
her legs began to swell, the swelling being accompanied with 
erythematous redness and a vesicular eruption, discharging a 
watery exudation which formed yellowish crusts. This erup- 
tion was accompanied by burning and pain, and a great deal 
of itching. The hands were swollen. The eruption also ap- 
peared on the head and back. Four seances of central galvani- 
zation completely cured her, the length of the application be- 
ing about fifteen minutes, and being made about twice a week. 
She has at present a good appetite, and is gaining flesh. There 
is no sign of the eruption." 

Dr. Mann has also treated several cases of pruritus and 
other diseases. 

In herpes zoster I have had success, as the following case 
will show : 

II. M. O.j twenty-six years of age. The patient had been af- 
fected for some time with a vesicular eruption on the right side, 
beginning in the groin and arching over the crest of the ilium, 
extending as far back as the vertebral column. Two successive 
patches had appeared, and he was so tortured with neuralgic 
pains as to lose all rest. I applied a metallic electrode (nega- 
tive) to the eruption itself, and the positive pole over the lum- 

1 Dr. Edward Frankel, of New York, informs me that he has had a case under 
his charge where eczema was associated with chorea, and that the subsidence of the 
latter disease was accompanied with a disappearance of the eczema. 

3 Medical Record, October 1, 1872, p. 412. 



TREATMENT OF SKIN-DISEASES BY ELECTRICITY. 131 

bar vertebrae. The pain disappeared in two or three minutes ; 
and, when I next saw him (a week afterward), the eruption had 
completely dried up. 

Barensprung supposes the origin of herpes zoster, to be 
an inflammation of the sympathetic fibres of the small spinal 
ganglion. This, he thinks, accounts for the neuralgia. 

The rapidity with which my case recovered fully goes to 
prove the above statement. 

Dr. H. Gr. Piffard, of New York, has had remarkable suc- 
cess. A case of scleroderma, which would not yield to other 
treatment, was very soon cured by this means. Dr. A. D. 
Rockwell informs me that he cured a person with tinea circina- 
tus in one seance. 

III. Psoriasis treated exclusively with the Galvanic Cur- 
rent. — The patient was forty years of age, a native of Ireland, 
and had suffered from psoriasis for seven years. The diseased 
patches occurred on the elbows, shins, back, and below the 
breasts, varying from one to three inches in diameter. Her 
general health was good, but she occasionally suffered from ova- 
rian irritation. Carbolic acid (internally) and arsenic were first 
tried, but found to be useless, upon which Dr. Piffard deter- 
mined to treat her by galvanism. The positive pole of the 
battery was applied to the nape of the neck, and a negative 
pole, with sponge-electrode, was passed over the surface of the 
affected patches. The strength of the current was regulated 
by the sensation of the patient, the intensity being as great as 
could be borne without discomfort. The application varied in 
duration from one to three minutes for each spot. Without 
entering into a full description of the progress of the case, 
which is extremely interesting, suffice it to say that the pro- 
gressive improvement occurred — noticed especially in the patch- 
es, to which the applications were made with greatest frequen- 
cy — and in about six weeks the disease had entirely disappeared. 
During the entire period of galvanic treatment the patient re- 
ceived no external or internal treatment, with the exception 
of a little rhubarb and soda given during the first week. Dr. 
Piffard, at his dispensary, has employed the continuous current 
in several cases of eczema, in pityriasis of the scalp, in sclero- 
derma, seborrhcea, and in one case of enlargement of the nose 



132 CLINICAL ELECTRO-THERAPEUTICS. 

depending upon great increase in size of the sebaceous follicles 
with infiltration of the interfollicular tissues, and in one case 
of non-parasitic sycosis. The doctor ends a most interesting 
communication by stating that " the results thus far obtained, 
though by no means uniformly successful, are sufficiently en- 
couraging to warrant further observation of the effect of this 
agent upon morbid conditions of the integument." * 

1 Reported by Dr. H. G. Piffard, in The Doctor, August 1, 1871. 



CHAPTER XI. 



ELECTROLYSIS. 



Theory of Electrolysis. — Anions and Cations, etc. — Steps of Operation. — Needles 
and Apparatus. — Electrolysis of Aneurisms (Galvano-puncture). — Malignant, 
Erectile, and Serous Tumors. — Goitre. — Hydatids. — Hydrocele. — Stricture. — 
Galvano-therapy of Wounds and Ulcers, Nsevi, etc. 

Before we enter into the consideration of electrolysis as a 
therapeutical means, it may be well to briefly consider its phi- 
losophy. Electrolysis is eminently a chemical process, and may 
be defined as a change or division of a compound tody through 
the catalytic agency of electricity. We call a substance capable 
of such analysis, an electrolyte. All substances are good elec- 
trolytes which contain water, and the quantity of water and 
soluble salts they contain gauges their conductibility and ca- 
pacity for electric decomposition. 

When the positive and negative poles are immersed in a 
fluid, we find that the decomposed parts of the substance col- 
lect at the respective poles, and to those that are decomposed 
at the positive pole we give the name anions ; at the negative, 
cations. 

When we decompose water, we find, for instance, that oxy- 
gen is set free at the positive pole, and hydrogen at the nega- 
tive ; therefore they are respectively anion and cation. 

The different tissues found in the body, whether they be 
heterologous or homologous, are capable of being disorganized 
by this action. I have spoken before of the phenomena ex- 
hibited when blood is submitted to this process ; other fluids 
and substances are subject to changes also. Some writers, 
among them Dr. Neftel, of this city, state, and prove their as- 
sertion with cases, that malignant growths may be destroyed 



134 CLINICAL ELECTRO-THERAPEUTICS. 

by an electrolyzation of their substance. 1 Neftel goes so far as 
to say that it exercises a constitutional effect in suppressing or 
neutralizing a cancerous diathesis ; " the cancer-cells have their 
protoplasmatic contents so altered as to make the formation of 
new deposit impossible." Electrolysis may be used for the dis- 
persion of tumors or morbid growths, or collections of serous 
fluid. 

For the operations of electrolysis we require a battery capa- 
ble of producing currents of tension without too great " quan- 
tity." With quantity we get heat, and this is fatal to success. 

Electrolysis may be performed either by external 2 or inter- 
nal action. . For the former method we may apply flat sponges 
or plates of metal ; for internal electrolyzation we use needles. 
There has been so much dispute upon this point that I hesitate 
in recommending any particular kind. Zinc, platinum, silver, 
and gold, have been lauded. 3 Dr. Keyes, in the performance 
of some very valuable experiments last year, tried hollow 
needles for aneurisms, but abandoned their use ; he finally ar- 
rived at the conclusion that gold were the best. In my experi- 
ence, steel needles covered with gold, and afterward insulated, 
were most reliable. Dr. A. D. Rockwell says : 4 "It has been 
found that electrolytic action is very materially modified accord- 
ing to the nature of three important factors : 1. The composi- 
tion of the substance decomposed. 2. The material of which 
the electrode is made. 3. The strength of the current em- 
ployed." 

Under the first head we will find that some substances de- 
compose much more readily than others ; under the second, 
that some electrodes are better conductors of the current than 
others, or are more oxidizable ; and, on consideration of the 
third, we find that a condensed current (that is, when greater 
resistance is offered by a small needle or conductor) will pro- 
duce electrolytic effects much more quickly and effectually than 
when the current is diffused. The action of the current, when 

1 Medical Record, September 1, 1869. 

2 Baumgartner's experiments clearly prove that an electrolytic effect follows ex- 
ternal transmission of the current. 

3 New York MedicalJournal, July, 1871, p. 3. 

4 " Practical Electro-Therapeutics," New York Medical Journal, December, 1871, 
p. 577. 



ELECTROLYSIS. 



135 



two needles connected with the poles of a battery are thrust 
into a piece of animal tissue, is as follows : At the positive 
pole, the formation of acid will coagulate the albumen, and 
render the parts in the vicinity tough and hard. At the nega- 
tive, the surrounding parts are shrunken. 

When the two needles are thrust into a cavity filled with 
blood, we have the phenomena described in a previous chapter. 
Litmus-paper will demonstrate the presence of acid at the posi- 
tive pole, and at the negative pole the original color will be 
restored. 

Electrolytic effects may be produced in other ways, by ex- 
ternal application. When a deposit or exudation, which is the 
fig. 45. product of disease, is treated in this manner, the sub- 
stance is disorganized, and the vessels dilated so that 
they remove the disintegrated matter. In goitre and 
other like diseases, in the exudations of rheumatism, 
etc., this process goes on till the enlargement is finally 
reduced. Dr. Murray has been in the habit of using 



Fig. 46. 




the needle shown in Fig. 45 ; while, for cases where many 
needles are to be inserted, several instrument-makers make 
the apparatus, Fig. 46. For general use, I strongly advocate a 
large steel gilt needle, well insulated to within a few lines of 
its point. 

When we insert two needles of this kind into a tumor, a 



136 CLINICAL ELECTRO-THERAPEUTICS. 

chemical action takes place, absorption is induced, and disin- 
tegration and atrophy finally occur. 

We should test the strength of the battery before proceed- 
ing with the operation, and this may be done by the decompo- 
sition of a solution of iodide of potassium. The rapidity with 
which the evolution of free iodine occurs, will give some idea 
of the intensity of the current. 

Electrolyzation of Aneurisms — Galvano-Puncbure. — Cini- 
selli has been the great worker in this field, and his success 
has been more evident than that of any other operator. In a 
thesis written over three years ago, I traced as faithfully as 
possible the history and success of this mode of treatment ; 
since that time others in this country have taken up the subject, 
and have given their results to the public. Dr. Keyes, of this 
city, in the summer of 1871, experimented most carefully, and, 
after trying galvano-puncture in a case of aneurism of the ab- 
dominal aorta, came to the conclusion that, though his case was 
not cured, it is well to attempt this treatment in abdominal 
aneurisms ; that in these cases peritonitis is not necessarily 
produced, and that the danger of the operation is inconsider- 
able . 

Dr. R. S. Lincoln, 1 also of New York, treated an aneurism 
of the arch of the aorta more successfully, and, in an article 
relating his case, finally says : " We have grounds for encour- 
agement that promise a measure of success where formerly a 
speedy death seemed inevitable." 

The action of the current in the aneurismal cavity is attend- 
ed by a deposition of fibrine in the neighborhood of the posi- 
tive pole, and this eventually fills up the aneurismal sac. The 
appearance of a positive clot may be seen in Fig. 47. This 
fibrous structure is deposited on the sides of the sac in lamina- 
tions which can be readily stripped from one another. When 
the aneurismal cavity is filled, this lowly-organized structure is 
gradually absorbed, as is the rule with the majority of false 
membranes and tissues found in other parts of the body. 

Having considered the pathology of the process, I will now 
speak of the operation. For some weeks before, the patient 
should be put upon as nearly a perfect animal diet as is con- 

1 Medical Record, May 15, 1871. 



ELECTROLYSIS. 137 

sistent with health, with the idea of increasing the plastic ele- 
ments of the blood. For several days previous to the first 
operation, he should be given digitalis or aconite. During the 
operation, a large room with plenty of fresh air is conducive 
to success. 




Fig. 47.— Microscopic appearance of a blood-clot from the end of a galvanic needle. 

The patient should be laid on a low bed, perfectly level, 
that the circulation may be equable and unconstrained ; the sur- 
face should be kept warm, and the surroundings be such that 
the patient's mind may not be excited by any of the prepara- 
tions. On one side (usually that nearest the part to be operated 
upon) a small table is to be placed, on which the battery is laid. 
An assistant watches the pulse, while another administers the 
anaesthetic, ether being the most desirable. 

When the patient is fully anaesthetized, which is necessary, 
for the pain is intense, the operator, taking the positive needle, 
which is gilded and coated with some insulating substance, and 
the negative, a metal plate, covered with sponge, inserts the 
former to such a depth that several lines uninsulated penetrate 
the cavity, and holds the latter (the sponge having been moist- 
ened) at a point as nearly opposite the insertion of the positive 
as possible. 



138 CLINICAL ELECTRO-THERAPEUTICS. 

The battery, which should consist of at least twenty-five 
cells, is let gradually on, using but few cells at first, and in- 
creasing gradually as the operation goes on. The assistant at 
the pulse now will feel a great irregularity in its action, increas- 
ing at first, generally, next decreasing, and remaining so. 

The tumor will become red, oedematous about the entrance 
of the needle (positive), and greatly distended, by the rapid for- 
mation of gas in the interior ; at the same time, there will be 
a rapid increase in the temperature, and, if this continues in 
violence, we may safely judge that a secondary inflammation 
will follow. The point of application of the negative sponge 
will be vesicated and excoriated. 

After withdrawing the needles, at the expiration of such a 
time as the judgment of the surgeon shall suggest, the finger 
should be placed over the point of entrance. Should haemor- 
rhage occur, the liquor ferri persulphate will quickly stanch the 
slight flow ; but, if all is well, the opening may be closed by a 
small piece of adhesive plaster. 

In removing the needle the operator often finds difficulty, 
for large masses of clot may render its withdrawal no easy 
matter ; a steady, careful traction, will effectually accomplish 
the matter, however. 

The needle is always corroded by the excess of acid gener- 
ated, and often it is found to be reduced in size to a mere hair. 

The time during which the needles are allowed to remain 
in the cavity depends greatly on the size of the tumor, and the 
force of the current. Cases have been known in which twenty 
minutes sufficed to completely solidify the growth and stop all 
pulsation. If a moderate seance of from fifteen to thirty min- 
utes is not sufficient, a repetition of the operation may be per- 
formed. Niccoli made as many as six operations in a week, 
though it is best to allow longer intervals to elapse, that the 
inflammation may not be too violent. Dr. Keyes used the cur- 
rent for over an hour in one case ! 

It is advisable to press the distal ends of the artery or arte- 
ries, which the aneurism involves ; by this precaution coagula- 
tion is rendered easier, and the possibility of the detachment of 
small pieces of the clot that might form emboli is prevented. 

I deem it important to again refer to the pain which inva- 



ELECTROLYSIS. 139 

riably accompanies the operation, and the necessity for an an- 
aesthetic. The Italian surgeons unanimously affirm that the 
pain is intense, and Phillips states that in several of his cases 
the patients fainted from sheer physical exhaustion. 

During the operation a " moist rale " will be audible ; this 
is caused by the rapid evolution of small bubbles of gas rising 
to the surface and breaking ; they are chiefly hydrogen gas, 
and are liberated from the negative pole. 

Coagulation not occurring in such a degree as to fill up the 
aneurism completely, a mechanical deposit of fibrine effects the 
final solidification. If this does not follow, a mild inflamma- 
tory process, from the heat generated during the operation, fills 
the sac by its products. The success of the operation depends 
on the following conditions, viz. : 

1. The size of the aneurism. 

2. A proper insulation. 

3. The exact amount of galvanic force. 

1. In large aneurisms, with thin walls, and violent pulsa- 
tion, the success of the operation is not evident ; not only is 
the production of a galvanic clot a difficult matter, but so great 
is the force of the circulating current, that the process is highly 
impracticable. 

2. A proper covering of the needle by some non-conductor 
is of the utmost importance. If this is not carefully attended 
to, the heat produced by a large exposed non-conducting sur- 
face will give rise to a violent secondary inflammation, so se- 
vere that the entire sac may subsequently slough away — a most 
unhappy occurrence. 

Another deplorable danger, and one that has seriously affect- 
ed the success of the earliest operators, is the sloughing of the 
track of the non-insulated needle. When, in such cases, the 
slough separates, it will come away in the form of a cone, the 
base above ; the diffusion of the current in this shape is sup- 
posed to account for it. The consequences, secondary haemor- 
rhage, can be fully realized. 

To prevent these dangers, the needle has been insulated by 
various substances with different success. Petrequin recom- 
mends wax; Broca, shellac; Phillips, black enamel; Keyes, 
hard rubber, etc. 



140 CLINICAL ELECTKO-THERAPEUTICS. 

The following is a formula with which I coated the needles 
successfully used in a case to be presently alluded to. None of 
the destruction of tissue followed, and but a slight black spot, 
with a few enlarged surrounding capillaries, marked the en- 
trance : 

I£ . Gum-shellac (brown) 1 drachm. 

Solution India-rubber (Squibb's) 1£ " 

Wood Naptha 2 " 

3. The force and power of the galvanic battery should be 
carefully regulated. Too great an action may form a very 
curdy, loose clot, easily broken up by the circulating blood, and 
carried off as emboli. 

This production of emboli Morgan 1 denies, and insists that, 
when existing, they are but small fragments, torn from the 
sloughing membrane, that always is found after the operation 
in some amount. The rapid evolution of gas may seem dan- 
gerous, when the action is exceedingly violent, but Eysten 2 
found that from forty to one hundred per cent, of air had to be 
suddenly introduced into the jugular vein to produce death — 
much more than is possible here. 

Too weak a current will prevent the formation of clots. 

The dangers of the operation have indeed been magnified, 
and assuredly upon slight foundation. In the crude workings 
of the earlier experimenters on the subject, a general want of 
proper knowledge and apparatus has defeated success. It must 
be evident to all that proper manipulation and care will assist 
the intelligent surgeon to make the procedure a safe and valu- 
able one. The discoveries of the Italians were characterized 
by the peculiar implements with which they worked. Perhaps 
the most striking example was the galvanic pile of Yolta. This 
apparatus was even used by Petrequin and Broca a quarter of 
a century ago. 

Having considered the most interesting points of the opera- 
tion, it is well to inquire into its applicability and chances of 
success. The most striking cases are those for which we can 
usually give no relief, and cannot do more than tell the patient 
that he must die. These are aneurism of the great vessels ; 

1 Morgan, "Electro-Physiology and Therapeutics." 
8 Bouillard,- " L'Introduction de l'Air dans les Veins." 



ELECTROLYSIS. 141 

abdominal and thoracic aorta, the innominate, subclavian and 
iliac arteries, when ligation or other measures may be imprac- 
ticable or impossible. In cases where great debility is present, 
we may employ this process. 

As in all other surgical operations which have been given 
to the world, we are unable to obtain exact reports, either of 
success or not, and the statistics preserved are neither com- 
plete nor definite. I have, however, obtained the following : 
Bovinet, 1 in a report made in 1853, gave thirty-two cases of 
aneurism treated. Of these, twenty-one were unsuccessful, 
one doubtful, and ten successful. Of these ten, seven were 
situated upon the small arteries of the extremities, and, in the 
three others, two popliteal and one subclavian, suppuration fol- 
lowed. One of the popliteal cases, moreover, left the hospital 
with a tumor, as large as a hen's-egg, under his knee. 

Petrequin reports sixty cases, seven of which died, twenty- 
three were cured, twenty were not ; the rest were doubtful. 
Petrequin operated three times successfully on the subclavian. 
Niccoli successfully treated two cases of aneurism of the aorta, 
and another of aneurism of the facial artery. Sir ¥m. Hamilton 
reports a successful case of aneurism of the carotid ; Schuch one 
unsuccessful case of subclavian aneurism ; Ciniselli reports twen- 
ty-three cases, out of which sixteen died and six were cured, 
one disappeared ; Genmireau, of Pisa, one of palmar ; Dr. H. B. 
Sand, of iS T ew York, one of subclavian, which was unsuccessfully 
treated ; Dr. E. L. Keyes, of New York, one of abdominal 
aneurism, which was also unsuccessful. This makes a total of 
one hundred and twenty-six cases, of which, as far as I can learn, 
forty-eight were cured ; the rest were doubtful, or not cured. 

I. Case of Aneurism of the Subclavian? — P. K., a sailor, 
nineteen years old. He had fallen from the foretop of the vessel 
and had struck upon his chin, thus causing a sudden and vio- 
lent extension of the neck. This occurred eight weeks ago. 
Besides this, one or two lacerated wounds of the soft parts 
covering the inferior maxilla. No injury was discovered at the 
time of the accident. A few days afterward, however, the pa- 
tient began to suffer from slight pain and numbness in the arm 

1 " Des Anevrismes et de lew Traitement," Paris, 1856. 
8 Dr. H. B. Sand's case. 



142 CLINICAL ELECTRO-THERAPEUTICS. 

and shoulder, and in the course of a fortnight a pulsating tumor 
was noticed on the right side of the neck, close to the larynx, 
and at that time had acquired very formidable dimensions. It 
occupied most of the lateral triangle of the neck, and extended 
inward beneath the sterno-cleido-mastoid muscle as far as the 
median line. Its shape was pyramidal, the apex somewhat 
rounded off, reaching as high as the top of the larynx, while 
the base extended downward behind the clavicle and sternum. 
The sternal end of the clavicle was partially dislocated forward 
and pulsated strongly, as did all those portions of the tumor 
which could be examined. The aneurismal murmur was also 
exceedingly well marked. The pupil of the right eye was con- 
tracted, probably from the pressure of the tumor upon the cer- 
vical portion of the great sympathetic. The tumor itself was 
very readily compressed, showing that its contents were fluid. 
The pulsations of the right carotid and brachial arteries were 
more feeble than those of the corresponding vessels of the oppo- 
site side, the difference, however, being only slight in the caro- 
tids. " On the outer side of the tumor the finger could be passed 
behind the clavicle, and, by pressing in the direction of the first 
rib, I was able to arrest the pulsations of the radial artery." 

In regard to diagnosis, no doubt existed as to the character 
of the aneurism. Further examination revealed an aneurism 
of the first part of the subclavian. 

The magnitude of the aneurism and its proximity to the 
great trunks, combined with the low state of the patient, pre- 
cluded surgical interference by the ligature. Pressure (digital) 
was tried, however, by twelve students. This was commenced 
on the 23d of March and continued for twenty-six hours, but 
the only result was a large ulceration of a gangrenous nature, 
produced by the fingers of the operators. This largely covered 
the sac, and at one time threatened to eat through the sac wall 
and produce secondary haemorrhage. 

On the 15th of April, with the aid of Dr. Gueleke, of this 
city, gal vano- puncture was performed. One gilded needle in- 
sulated was attached to the positive pole, while the negative 
was fastened to a handle holding a steel plate covered by sponge. 
The elements were twenty in number, and were a modification 
of Bunsen. 



ELECTROLYSIS. 143 

The needle was introduced at the upper part of the sac — the 
negative sponge was placed at the upper part of the sternum. 
The current was applied fifteen minutes. The pulse stood dur- 
ing the operation : 







'p.m. 


PULSE. 


Needle introduced 




5.09, 


140 






5.12, 


128 




15 minutes - 


5.14 


120 






5.16, 


136 






5.19, 


120 






. 5.24, 


needle removed. 



During the operation a slight tumefaction was noticeable ; 
at the negative spot the skin was vesicated. No bad effects 
followed. May 22d, operation repeated. May 26th, again — 
each operation lasting fifteen minutes. Notwithstanding the 
tumor became firmer, it enlarged so rapidly and produced so 
much pain that, at the patient's request, galvano-puncture was 
not repeated. On the 9th of June the patient was suddenly 
stricken down by the bursting of the aneurism externally ; the 
haemorrhage recurred on the 12th, and proved fatal. The rup- 
ture took place through the ulcer. 

Post-mortem examination showed that the aneurism in- 
volved the first part of the subclavian ; that it was produced 
by the forcible tearing away of the thyroid axis. The internal 
jugular vein, pneumogastric nerve, and carotid, are pushed, with 
the larynx, far to the left of the median line. 

When the sac was laid open, over three pounds of coagulum 
were found. At the entrance of the needles, exteriorly, were 
two or three little charred spots, while internally large masses 
of white, stratified fibrinous clots were attached at these points. 
This clot must have occupied nearly two-thirds of the sac. " It 
is impossible to avoid the conclusion that, in this case, galvano- 
puncture, though it failed to cure the disease, yet caused the 
deposit of stratified fibrine to an extent which, in a less formi- 
dable aneurism, might have brought about the desired result/' 

A Case of Aneurism of the Arch of the Aorta, treated oy 
Electrolysis* February 6th. — Mr. H., a miner, was brought to 
me for consultation by his physician, Dr. Stearns, of Buffalo. 
The history of the patient was as follows : 2 

1 Treated by Dr. R. P. Lincoln, of New York. 2 Medical Record, May 15, 1871. 



144 CLINICAL ELECTRO-THERAPEUTICS. 

He was thirty-seven years of age, born in Vermont. For 
several years he followed the sea as a common sailor, but for 
the past live years he had worked in the mines of California. 
His general appearance was that of an active, robnst man. He 
had never suffered from illness other than intermittent fever. 
There was no history of syphilis or rheumatism. He was not 
conscious of ever having overtaxed his strength in lifting or 
otherwise. On the 15th of last June, while leisurely walking, 
he fell, and on rising found he did not have perfect control of 
the right half of the body, and that there was some numbness 
throughout the same side. During the succeeding twenty-four 
hours he sustained six of these shocks, losing consciousness 
during only the last two, which continued but ten or fifteen 
minutes, though the impairment of sensation and motion per- 
sisted from the first, and was never wholly recovered from. 
Immediately following those attacks, he suffered pain in the 
right shoulder, extending up the side of the neck and head, 
and two or three weeks later in the left also, in both of which 
it had continued with increasing severity. About December 
1st, a small pulsative tumor was discovered in the peri-sternal 
notch, which has steadily increased in size ; within the two 
weeks previous to my seeing him it had doubled. He could 
swallow only liquid food, breathed rather loudly, and within a 
few days had some cough, the cause of which was not removed 
by the effort. His radial pulse was 112, regular and equal in 
both wrists, but weak ; there was no pulsation in the left caro- 
tid. The laryngoscope revealed nothing of importance. 

To inspection there was presented a uniformly rounded 
tumor situated in the median line, and extending from the po- 
mum Adami to one inch below the normal situation of the up- 
per margin of the manubrium, the latter having been absorbed 
to that extent. The sternal ends of the clavicles were dislo- 
cated forward. The larynx and trachea were crowded slightly 
to the right, but the prominence of the tumor was equal on 
either side of the median line, and measured over its apex, 
either transversely or vertically, four inches and a half. The 
apex of neither lung seemed to be encroached upon, percussion 
of these being normal both in front and behind, and respiratory 
murmur natural. The pulsation and sounds of the heart were 



ELECTROLYSIS. 145 

both natural. To palpation the tumor was elastic and pul- 
sating, with a distinct thrill, and, on applying the stethoscope, a 
distinct whiz, with each pulsation, over the whole tumor, that 
could be traced as far as the heart. I diagnosed an aneurism 
of the arch of the aorta, and advised, as the only means of re- 
lief, electrolysis combined with a modification of the method 
known as Valsalva's. The patient was seen at this time by 
Dr. Sass, and also by Prof. Markoe, who approved of the course 
recommended, the latter thinking it probable, from the position 
and size of the tumor, that the innominate artery was involved 
at its origin. 

" The patient left the city, but returned, so that the first 
operation was made February 20th. ' 

" During the time (two weeks) that had elapsed, the tumor 
had apparently doubled its size, and measured six and one-half 
inches, where it measured but four and one-half before. The 
pain in the shoulders was now so great as to prevent more than 
two or three hours' sleep at night, and he was weaker in every 
respect. For four days previous to the first operation the pa- 
tient was kept in bed, and iron, quinine, and digitalis, admin- 
istered by day, and morphine at night. At the time of the 
operation all the symptoms were aggravated, except the pulse, 
which was 104. 

" The method practised by Ciniselli was followed in the oper- 
ation as far as practicable, and was only modified as the nature 
of the case seemed to demand. Seven steel needles, insulated 
to within one and a half inch of their points, were introduced 
into the prominent parts of the tumor, one inch and three- 
fourths below the surface of the integument, and three-fourths 
of an inch from each other. The cathode and anode were each 
subdivided into two, and the positive pole preceded the nega- 
tive as the current passed through each. Every time the poles 
were changed the number of elements was increased from one 
to ten, the battery used being a modification of Stohrer's. Eo 
anaesthetic was used in this or the following operation, and the 
increase of the pain forbade the use of a larger number of ele- 
ments. The current was closed forty minutes in all. 

" During the operation the diminution of the distinctness 
of the pulsation was very marked, and the patient complained 
10 



14G CLINICAL ELECTRO-THERAPEUTICS. 

only of a burning pain, which became greater with the in- 
crease of the number of elements. On removing the needles, 
gas escaped for a few seconds from each puncture, and with 
the gas small pieces of clotted blood. The pulsation had almost 
entirely ceased, and the tumor had a hard feel and was some- 
what distended. The integument over the tumor was red. 
An ice-bag and a wet compress were ordered to be kept on the 
tumor, and perfect quiet enjoined. The amount of food was 
restricted — fluids withheld as far as possible ; there were pre- 
scribed ten drops of the tincture of digitalis every three hours, 
and one-fourth of a grain of the sulphate of morphia at night. 

" 21st. — Pulse 104. He passed a comfortable night. Pul- 
sation of the tumor is more marked than after the operation, but 
not to the degree that obtained before, and the thrill was less 
distinct. Eight ounces of blood were taken from the arm — 
other treatment unchanged. 

" 226?. — Erne a. m., pulse 100 ; comfortable. At nine a. m. 
his pulse began to increase in frequency, and he complained of 
faintness. Wine was administered, but these unpleasant symp- 
toms continued till I saw him at three p. m., when I found him 
much excited and nervous, with a pulse that could hardly be 
detected at the wrist, and with a fluttering heart. Fifteen 
drops of the digitalis with wine were given at once, and ten 
drops ordered to be repeated every hour, after which he quick- 
ly returned to his former condition. 

" 26th. — Pulse 98, less than for weeks ; feels better every 
way, though weak from confinement and restricted diet. The 
operation was repeated as before. Eleven elements were used, 
the current allowed to flow fifty minutes. The immediate re- 
sults were the same as before, but more marked, all pulsation 
in the tumor being arrested for the time, though it partially re- 
turned during the following twenty-four hours. 

" March 2d. — Electrolysis was again repeated, the patient 
taking ether, which Dr. J. O. Stone was kind enough to ad- 
minister. The number of elements was increased to fifteen, 
and the time to sixty minutes. The following gentlemen wit- 
nessed one or more of these operations : Drs. Markoe, Stone, 
Bumstead, Sass, Farnham, Noyes, Burrall, Sturgiss, Goodwillie, 
and Stevens. 



ELECTROLYSIS. 147 

" Circumstances rendered it necessary for the patient to 
leave the city, though further repetitions of the electrolysis 
were advised, and arrangements were made to have this done, 
and the principles of this method of treatment carried out after 
leaving the city. 

" On the 9th of March, when I last saw him, his condition, 
compared with that before treatment began, was as follows : I 
could not discover that the tumor had increased in size ; its 
pulsation, thrill, and murmur, were much less distinct, and its 
fluid contents evidently contained within a thicker and firmer 
wall. The pulse, which before the operation averaged 112, was 
reduced to 90 per minute. The pain in the shoulders, though 
still considerable, was much less acute and more bearable, so 
that he was able to get more sleep at night. There was no in- 
jury to the integument from the needles, their insulation act- 
ing perfectly satisfactorily, all the inflammation at the points 
of introduction and its neighborhood having entirely subsided 
before the next operation.'*' 

Cirsoid aneurisms which consist of a congeries of enlarged 
veins and arteries have been successfully treated by Meyer. 1 
Yaricose veins have also been treated, but unsuccessfully in 
most cases. The operation is sometimes indicated in varico- 
cele. Schuch operated upon four cases of varicose veins, but 
not till after thirteen applications was a cure slowly effected. 
Malgaigne treated a young girl, who suffered with an aggra- 
vated case of this kind, with perfect success. There is no dan- 
ger of phlebitis. The current should be passed through the 
positive needle into the enlarged vein, and the sponge-covered 
negative plate should be held upon the skin at a distance. 
Several operations are usually necessary ; and, to obviate the 
trouble of an anaesthetic by the lungs, the spray-producer may 
be used. 

THE ELECTROLYTIC TREATMENT OF TUMORS. 

The use of electricity is rather a dernier ressort in malignant 
growths, although cases have been related by various authors 
attesting its success. Dr. Neftel has cured several patients, but 
it is difficult to see how galvanism actually neutralizes (as it is 

1 Meyer, p. 469. 



148 CLINICAL ELECTRO-THERAPEUTICS. 

claimed) cancerous matter, and removes all traces of its malig 
nan t nature. Dr. Neftel 1 reports a case in the Medical Rec- 
ord, which is as follows : 

The tumor had been removed twice before the operation by 
electrolysis. The last time it reappeared, it attained the size 
of an orange before the patient came under Dr. Neftel's charge. 
The tumor was found to be carcinomatous by the microscope. 
The operation was performed three times, with ten, twenty, 
and thirty elements, and seances lasting two, five, and ten 
minutes. After the operation, the tumor was much larger and 
softer than before. It gradually began to disappear till the end 
of the second month, when no vestiges of the original growth 
were seen. There was no return of the tumor. 

Dr. A. Jacobi and others have had cases that have recov- 
ered. Dr. J. Sinclair Holden, 2 physician to Lome Union Hos- 
pital, London, reports an unsuccessful operation upon a recur- 
rent fibroid tumor. The patient, a young woman, had a malig- 
nant tumor occupying the infra-spinal portion of the scapula. 
It had begun to press upon the trachea, as it involved the en- 
tire side of the neck. Dr. Holden used Smee's battery with 
six cells ; four needles were introduced, two positive and two 
negative. The current (continuous) was applied three times a 
week for the space of a quarter of an hour. The result was 
that the part acted upon decreased in growth, and the surround- 
ing parts grew rapidly.. 

Faradization may be used as a local anaesthetic in cases of 
scirrhus. If it is applied about the diseased parts, much com- 
fort can be given to the patient. Erectile tumors yield readily 
to electrolysis. Dr. Sass, of New York, had a most remarkable 
case, which he treated with the greatest success. The patient 
was a prominent officer in the United States Army, aged thir- 
ty-three, and suffered from a small erectile tumor situated on 
the left side of the neck, in the ant ero -inferior portion of 
the region defined by the sterno-cleido-mastoid and trapezius 
muscles, and the clavicle. This appeared six weeks after an 
unusual strain upon the voice, and, when seen by Drs. Sims, 
Sass, and R. P. Lincoln, annoyed the patient terribly, as its 

1 Medical Record, September 1, 1869. 

2 British Medical Journal, March 16, 1872, p. 287. 






ELECTROLYSIS. 149 

pressure upon the trachea greatly interfered with respiration. 
Any cause, such as indigestion, active exercise, and mental ex- 
citement, would increase its size notably. On the 30th of Sep- 
tember, 1870, the patient was anaesthetized, and four gilded 
steel needles were introduced into the four quarters of the tu- 
mor — the two upper being one and one-fourth inch apart, and 
one inch above the lower, which were one inch apart. The 
two inner were connected with the cathode, and the two outer 
with the anode. Ten, then fifteen elements of Stohrer's bat- 
tery were used. The strength of the current was gradually in- 
creased. At the end of fifteen minutes the two lower needles 
were removed, thus concentrating the force of the current on 
the two upper. 

During the operation the prominence of the tumor disap- 
peared, and was substituted by a hard mass. The skin over 
the tumor presented a bright blush, and the trachea had re- 
turned to its proper place. The patient kept quiet for three 
days, and kept a cold-water compress to his throat. 

October 24:th. — The tumor was diminishing in size, and the 
patient was entirely well. 1 

Nsevi have been treated in this way, but a better means for 
their removal is the galvano-cautery. 

I have personally witnessed the good effects following elec- 
trolyzation of goitres. Althaus speaks very encouragingly of 
this treatment. Of course, the treatment must occupy a long 
time, and we must have patience. The case which follows, 
however, is an exception to this rule, as the period between 
the first application and the last, when the patient's condition 
was so remarkably ameliorated, was very short : 

I. L. T., aged fifty-two ; Westphalia. I first saw the patient 
on March 20, 1872, when she presented herself with the follow- 
ing history : She had been in this country thirty years, and 
ten years ago a swelling appeared in the anterior part of her 
neck ; this increased, growing higher and larger, and interfer- 
ing with deglutition and respiration. On examination I found 
a large goitre, the skin over which was tense and glazed. This 
tumor occupied the entire anterior part of the neck, and meas- 

1 The facts of the above case I have taken from Beard and Rockwell's " Medical 
and Surgical Electricity," p. 656. 



150 CLINICAL ELECTRO-THERAPEUTICS. 

ured, at its largest circumference, fifteen and a quarter inches. 
The weight of the patient was one hundred and twenty pounds, 
her height, five feet Hve and a quarter inches. Galvanism was 
applied by means of two moistened sponges placed on either 
side. The current, from forty cells, was transmitted for a period 
of twenty minutes. During the seance the tumor became large 
and very red, and a severe coughing fit was produced. 

March 23d. — Patient breathes more easily. Thirty cells. 

28th. — Thirty cells. Tumor has decreased three-fourths of 
an inch. 

April 4:th. — Tumor measures fourteen inches. After the 
last visit she had pain, with difficulty of respiration. Forty 
cells. 

6th. — Goitre measures thirteen and three-quarter inches. 
Forty cells. 

11th. — Deformity much less. Patient desires to discontinue 
treatment. 

November. — Patient seen four months afterward ; no subse- 
quent growth of the tumor. 

M. Groh has made a series of experiments with differently- 
constructed batteries. He finds that strong currents are best 
adapted for those cases in which it is desirable that rapid de- 
struction should be effected, as in carcinoma ; but for the treat- 
ment of small tumors, and where the object is to produce co- 
agulation, those batteries should be used which consist of a 
small number of small plates. The pain accompanying the 
operation increases with the number of the elements. In the 
first series of cases he reports that he treated six patients in 
twelve sittings with the electrolytic current. JSTone of these 
patients were narcotized, and the pain was found to be sup- 
portable up to twenty elements. One of them was a man, 
aged thirty-nine, with hydro- sarcocele. Immediately after the 
application, considerable diminution of the consistence of the 
tumor was observed; and after four days it had diminished 
one-half. He has used electrolysis in various modes : with 
strong currents applied for a short time, and with weak cur- 
rents for a longer period ; the former in cases of angioma, haem- 
orrhoids or swellings, scrofulous lupus, condylomata, and sar- 
coma, and in all instances with good results. The application 



ELECTROLYSIS. 151 

of weak currents he thinks deserving of much more extended 
trial, as it has answered capitally in his hands. 

Pulvermacher's chains, and Garrat's metallic disks, may be 
worn over or about some tumors, with the effect of sometimes 
reducing them. I doubt if the galvanic action from these in- 
struments would be sufficient to accomplish any great reduction 
in the size of the growth. 

THE ELECTROLYZATION OF SEROUS TUMORS, ETC. 

Passing over the special consideration of encysted tumors 
with a word — and that is, that, besides affecting absorption, the 
constant current creates an adhesive inflammation of the sac- 
wall — we will discuss its merits in hydrocele. The older 
writers, who treated these effusions by the introduction of a 
canula and rough wire, were more apt to cure the patient by 
the irritation and inflammation produced by their instruments 
than by the electric current. Althaus recommends that an in- 
sulated needle connected with the negative pole be introduced 
fairly into the cavity of the tunica vaginalis, and the positive 
sponge should be applied exteriorly. The current should be 
passed for from five to seven minutes. One application is usu- 
ally sufficient. If the faradic current is employed, three or four 
operations are required. The galvanic current should be em- 
ployed. I append a case treated by Dr. Alexander Murray, of 
this city : 

" John McCaffrey, aged forty years, ship-carpenter, applied 
to me on the 17th of August, 1869, for treatment of a hydro- 
cele of the right side of the scrotum. He stated that two years 
ago, while at work in a ship-yard, he was struck accidentally 
with a piece of wood on the testicle. Inflammation followed. 
About four months before I saw the man, he noticed that the 
scrotum grew larger and softer, and caused a dragging pain in 
the side. 

" I tapped this hydrocele seven times in eighteen months, 
the quantity of fluid drawn off varying, at each operation, from 
twenty- seven ounces to seventeen ounces. He was unwilling to 
submit to any operation for a radical cure, lest he might lose the 
proceeds of a few days' work. He wore a suspensory bandage to 
support the scrotum. On the 9th of May, 1871, I introduced 



152 CLINICAL ELECTRO-THERAPEUTICS. 

a trocar and canula for the eighth tapping, withdrew the tro- 
car, and, before any quantity of the fluid had escaped from the 
sac, I inserted a platina wire as large as the trocar, connecting 
it with the negative pole of the galvanic battery, and, with the 
positive sponge- electrode over the scrotum, I employed a cur- 
rent, gradually increasing it until it produced pain. After thir- 
ty minutes I allowed the accumulated fluid (seventeen ounces) 
to run off, and then continued the use of the current for live 
minutes longer. 

" More than six months have elapsed, and I find upon ex- 
amination that there has been no reaccumulation of fluid, and 
that the right side of the scrotum is only a little larger than 
the left, with no sensation of weight or pain. There was but 
slight oedema for two days after the operation." 

Dr. Dittle 1 treated a hydrocele, which was benefited after 
three applications, each lasting fifteen minutes (the positive 
twice and the negative once in the tumor), so much that it 
was diminished to one-quarter its former volume ; the tunica 
vaginalis became hard and tough, and the tumor lost its trans- 
parency. This gentleman also experimented with varicose veins 
of the leg according to the same method, and had the result 
that contraction of the vessel to a hardened cord, and all sub- 
jective symptoms, disappeared. A varicocele, enormous in size, 
was contracted, after one introduction of four needles (attached 
to the platina-pole), to such dimensions that, after three weeks, 
the veins had the appearance of empty, hard, tough cords, and 
soon after followed by entire disappearance of the disease. 

Hydatids. — Drs. Fagge and Durham, and Dr. Forster, of 
London, have operated upon eight cases of hydatids in the 
manner described by Althaus in his treatise " On the Electro- 
lytic Treatment of Tumors." The two former gentlemen pre- 
sented a paper on the subject, at a meeting of the Royal Medi- 
co-Chirurgical Society. In each case two needles were passed 
into the tumor, and were connected with the negative pole of a 
battery of ten cells. The positive pole, terminating in a moist- 
ened sponge, was placed upon the surface of the abdomen. The 
current was allowed to pass for a period varying from ten to 

1 " Beitrage zur electrolytischen Behandlung," Oestr. Zeitschr. f. pract. Heilkunde, 
Nos. 17, 18, 1868. 



ELECTKOLYSIS. 153 

twenty minutes in different cases. The needles were then 
withdrawn. A little clear fluid in some cases appeared at the 
seat of the punctures. 

]STo preliminary tapping nor exploratory puncture was made 
in any case. The diagnosis rested on the facts that the patient 
had a rounded, elastic tumor projecting from the liver, and that 
this was cystie, as proved by the needles rubbing freely against 
one another in its interior, although introduced an inch or two 
apart. 

The operation was followed in most cases by rapid dimi- 
nution of the tumor, which, even shortly after the operation, 
became soft and flaccid. At the same time, in some cases, 
fluctuation became perceptible in the lower part of the abdo- 
men. 

Slight febrile symptoms, and more or less pain, in most 
cases followed the operation ; these symptoms, however, rarely 
lasted more than three or four days. In one instance they 
were entirely absent. In most cases the patients were able to 
get about in a few days, and some of them were discharged 
from the hospital at the end of two or three weeks. Even at 
this early period the tumor had already, in some cases, very 
manifestly decreased in size ; and, as a rule, this decrease, when 
once it had fairly commenced, steadily progressed. After the 
lapse of six months or a year, when each patient returned for 
examination, no trace of the disease remained; or, at most, 
there was only some ill-defined fulness of the epigastrium. 

In one case only the result still remained doubtful. In the 
remaining seven cases the favorable issue above described had 
already taken place. All the patients were in perfect health. 

In the latter part of the paper the results of electrolysis are 
compared with those of simple tapping — the operation which 
has hitherto been most successful in the cure of hydatid dis- 
eases of the liver. The authors claim for electrolysis that it 
rivals simple tapping in being unattended with immediate dan- 
ger to the life of the patient, and that it is to be preferred, 
inasmuch as (according to their experience up to the present 
time) it involves no danger of suppuration within the cyst, and 
consequent risk and suffering — results which often follow sim- 
ple tapping. 



154 CLINICAL ELECTRO-THERAPEUTICS. 

ELECTROLYSIS OF STRICTURES. 

The operation of electrolysis in stricture of the urethra has 
been the subject of much controversy among medical writers. 
Mallez and Tripier have operated most successfully in many 
cases, aud up to the year 1870 had performed thirty-one cures. 
Dr. Keyes, 1 of this city, discourages the operation. He passed 
an instrument of his own construction upon the patients with- 
out doing any good. Dr. Keyes recites his experience, states 
his cases, and convinces the reader that he has most carefully 
investigated the subject. 

The theory of the electrolysis of stricture is this : The 
slough produced where the negative pole touches is such as 
that produced by an alkaline caustic, and the cicatrix is soft 
and non-contractile. At the positive pole the cicatrix is retrac- 
tile, like that left by a burn or an acid. An instrument insu- 
lated to its end, where it terminates in an olive-pointed bulb, is 
connected with one pole (the positive), and passed into the ure- 
thra till it reaches the stricture. The other pole (negative) is 
held against some part of the. body in the neighborhood. Mal- 
lez and Tripier say that one operation is sufficient. Dr. Keyes' s 
conclusions are as follows : " Organic strictures may be widened 
by the passage of the negative current. Eecontraction takes 
place after this, as after all other methods (Mallez and Tripier 
to the contrary). Sometimes the urethra becomes continuously 
wider at the constricted portion. The operation is painful, and 
vesical symptoms are aggravated where they exist." 

From my own experience I find that the only beneficial re- 
sults that follow the use of electricity in these cases are those 
that occur when the current is very mild (not so strong as to 
produce sloughs or cicatrices). A mild current undoubtedly 
has an electrolytic effect which will eventually enlarge the 
point of stricture. 

Dr. Robert Neumann a has treated several cases of stricture 
successfully ; but, as two agents, galvanism and laminaria digi- 
tata, were used, we are left in the dark as to what virtue gal- 
vanism actually had. 

1 "Practical Electro-Therapeutics," New York Medical Journal, December, 1871, 
p. 587. 

8 Medical Record, July 1, 1872. 



ELECTROLYSIS. 155 

GALVANO-THERAPEUTICS OF WOUNDS AND ULCERS. 

We shall find that, when electric stimulation of a slowly- 
healing wound or ulceration is made, a most remarkable 
change in the appearance and behavior of the part will occur. 
Granulation will spring up, and a cicatrix as quickly form. So 
striking is the above experiment that, if systematic galvanic 
stimulation of an ulcer be made, it will heal in a very few days. 
In old indolent ulcers this treatment is far preferable to all 
others. We may either apply the faradic or galvanic currents 
by means of a metallic plate (zinc is preferred), or we may ad- 
just permanently a plate of silver to the surface of the ulcer, 
and a plate of zinc to some adjacent point on the healthy skin. 
These should be connected by a wire soldered to both. The 
perspiration from the skin beneath the upper plate, and the 
moisture upon the surface of the ulcer, will generate a feeble 
galvanic current. These plates may be fastened in place by 
adhesive straps, but the surface of the sore should be watched 
from day to day to moderate the action. 

Dr. Alexander Murray reports the following case : " A man, 
aged thirty, with seven ulcers upon the lower third of the right 
leg, applied to me for treatment during the month of October 
instant. These ulcers were of two years' standing, and, as the 
case appeared to me to be one favorable for testing the relative 
merits of the poles, the size and condition of each ulcer being as 
nearly as possible uniform, I selected four for treatment by the 
positive and three by the negative pole. I first cleansed the 
sores with a piece of sponge wet with a weak solution of chlori- 
nated soda, and having partially dried them I applied the flat- 
disk electrode. I applied the galvanic current as strong as 
could be borne to each ulcer, for the space of £.Ye minutes, oc- 
casionally wiping away any discharge. This treatment was re- 
peated every third day. In two weeks the healing process, in 
the four under the influence of the positive pole, was considera- 
bly in advance of that of the three under that of the negative." 

I have galvanized indolent buboes, and have induced granu- 
lations and final closure of the wound in a very short time. 
Dr. G. K. Smith, 1 of Brooklyn, and Dr. Snively, of the same 

1 Beard and Rockwell, " Medical Electricity," p. 661. 



156 CLINICAL ELECTRO-THERAPEUTICS. 

city, have both treated slowly-healing stumps after amputa- 
tion. 

Cicatrices, Anchylosis, etc. — In the Centralblatt fur die 
Med. Wissen., lately, Dr. M. Meyer gave his experience on the 
effect of galvanism on scars, contractions, and anchylosis. If 
the positive pole is placed on the scar in the muscle, with the 
negative pole on the opposite side of the bone or on the muscle 
at some distance off, a remarkable softening of the scar takes 
place ; by means of a frequent repetition of this operation for 
the space of three or five minutes, with a current only percepti- 
ble, but painless, the exudation disappears, and the skin of the 
scar becomes pliant and of normal color. Contractions caused 
by immovable bands very quickly yield to the positive pole ; 
those caused by muscular or tendonous scars disappear, by 
gradual softening of the scars ; those caused by contusion of a 
nerve, and for the most part accompanied by anaesthesia of the 
skin, give way most rapidly by the following method : the neg- 
ative pole is held to the anaesthetized skin, while the scar and 
contraction are touched with the positive pole. The swellings 
in the bones which are caused by the entrance of bullets very 
quickly go down, and often in a few minutes a marked and 
visible swelling may be influenced, while chronic nodes and 
scrofulous swellings of bones, again, only very gradually are 
lessened in size. In one case, the right median nerve was 
injured one inch below the axilla, the palm of the hand was 
without sensation, the upper arm could be raised only with 
great difficulty. In six weeks the patient was cured ; could 
raise the arm easily, and shut the last three fingers. The ring- 
finger alone was stiff, and its skin without sensation ; the 
thumb, too, a little constrained in its motion, and the pressure 
of the hand still weak. 

THE ELECTRIC TREATMENT OF N.EVUS, ETC. 

"When we meet with those bluish-red spots which are com- 
monly termed " birth-marks," we may remove them, if they 
are not too large, by the application of the negative pole. If, 
however, we find that they are raised above the level of the 
skin, and are purely naevi maternus, we must use a more se- 
vere method. We may then introduce into their substance 



ELECTROLYSIS. 157 

two or more wires connected with a galvanic battery, and pass 
a strong current. The rapid evolution of hydrogen at the neg- 
ative pole will be followed by disintegration of the growth by 
the mechanical pressure of numerous bubbles of this gas. The 
best results I have had were those following a heated condition 
of the wires or needles. Many operators make this distinctly 
one of galvano-causty. I have used a platinum needle, which 
is quite flexible ; this is attached to a steel point, and the 
growth literally sewed. When the wire is passed through the 
growth, I attach the two cords of a powerful galvanic battery 
(usually a galvano-causty battery) to either end by small 
clamps. The wire immediately becomes red-hot. I make sev- 
eral punctures of this kind. 

Dr. Alexander Murray, 1 when performing the operation of 

Fig. 48. 




electrolysis upon a nsevus, introduces the needles in the manner 
depicted in Fig. 48. Dr. Murray has been unusually successful 
in his treatment of these cases. 

Foreign literature is very prolific in statistics of this opera- 
tion. Dr. Maas, of Breslau, has collected 3 the histories of one 
hundred and twelve cases of nsevus treated by the galvanic 
cautery. The results were as follows : Capillary nsevus — cured, 
thirty-two ; improved, one ; result unknown, one. Cavernous 
or venous ngevus — cured, seventy-two ; improved, eight ; result 
unknown, one ; died, three. Arterial nsevus — cured, two ; im- 
proved, one. Nsevus combined with other tumors — cured, six ; 
improved, one ; result unknown, two. He derives from the 
examination of the cases the conclusion that the galvanic cau- 

1 New York Medical Record, November 1, 1872. 
8 Archiv fur klinwches Chirurffie, vol. xli. 



158 CLINICAL ELECTRO-THERAPEUTICS. 

tery is followed by the best results in naevus, and is much safer 
than the injection of perchloride of iron or any other coagu- 
lating fluid. It would, however, be wrong to say positively 
that the remedy is indicated in all cases of nsevus. The sur- 
geon must take the circumstances of each case into considera- 
tion. 



CHAPTER XH. 

GALVANO-CAUSTY, ETC, 

Batteries, Electrodes, etc. — The Operation. — Cases. — Miscellaneous Uses of Elec- 
tricity. — Electric Baths. — Absorption of Inflammatory Products. — Spermator- 
rhoea. — Orthopraxy. — Vomiting of Pregnancy. — Detection of Metallic Sub- 
stances. — Carbuncles and Furuncles, etc., etc. 

The applicability of this process in many cases when the 
knife is impracticable, and its advantages over that instrument 
in certain instances, recommend it at once as a most valuable 
surgical means. Galvano-causty has been used lately in this 
country by the gynaecologists to a great extent, and abroad by 
other specialists in very many surgical diseases. The opera- 
tions for which it is specially indicated are the following : 

Removal of polypi, pediculated tumors, etc. 

Removal of cancerous masses from the cervix uteri and 
other localities. • 

Removal of haemorrhoids. 

The division of sinuses and fistulas. 

Cauterization of diseased surfaces. 

Cauterization of the vaginal walls for the purpose of caus- 
ing cicatricial contraction. 

Cauterization of ulcers. 

Amputation of the cervix uteri, etc. 

The advantages of galvano-causty are evident. Its use is 
attended by no haemorrhage, the parts acted upon being cau- 
terized most effectually. The cautery may be introduced in a 
cold state, and, when the instruments are adjusted, the opera- 
tion performed, and the cautery withdrawn, without any injury 
to the adjacent parts. It can be used in places where the em- 
ployment of the knife would be inconvenient or impossible. 



160 CLINICAL ELECTRO-THERAPEUTICS. 

The operation is comparatively painless ; there is no shock to 
speak of, and thus the danger is reduced to a minimum. 

There is very seldom any occasion for the use of the liga- 
ture or torsion ; there is consequently no haemorrhage. These 
advantages recommend it most highly. 

The rationale of galvano-causty is this : When a poor con- 
ductor of the electric current is placed between two good ones, 
and a current of quantity is sent through them, the poor con- 
ductor, from its inability to transmit the great amount of elec- 
tric fluid, will immediately undergo a rapid increase of tem- 
perature. 

Platinum is used as the resisting part of the circuit, and 
with a proper current it will become first red and then white 
hot. Certain conditions govern the selection of the cauterizing 
wire, and these are — 1. That it should be small and short. A 
large wire will require a greater current to raise its temperature 
than a small one. 2. The wire should always be platinum, as 
the other metals easily melt. 

Galvano-Causty Batteries. — The German surgeons are in 
the habit of using Middeldorpf s, Grenet's, and Bunsen's bat- 
teries. Most of these are inconvenient from the fact that it is 
troublesome to remove the plate from the solution after use, 
and that these foreign batteries are cumbersome and bulky. A 
galvano-causty battery must furnish a " quantity-current," and 
this can only be done by the use of large plates, and by con- 
densation of the poles ; that is to say, the negative poles of the 
several batteries should all be joined together, and the positive 
poles should be united in the same way, instead of one ele- 
ment, electro-positive, being joined with another, electro-nega- 
tive, and so on through the series, as is the arrangement in the 
batteries giving " intensity-currents." When all the elements 
of one kind, and all of another, are joined as I have just de- 
scribed, we have but two large plates, so to speak, and thus 
get a very powerful quantity current. The instruments of the 
Galvano-Faradic Company of New York (Fig. 49) are most 
excellent ; they are a greatly-improved modification of Stoh- 
rer's. By a screw on top, we are enabled to get a gradual in- 
crease of current, thus immersing the plates, or removing them 
entirely. When I spoke of polarization, I mentioned the fact 



GALVANO-CAUSTY, ETC. 



161 



that numerous small local currents were apt to generate upon 
the surface of the plates, also that the negative plate would be 
eventually covered by so many bubbles of the hydrogen gas 
that the strength of the current would be diminished. This 
condition is fatal to a uniform strength of current, and, as this 
is desirable in galvano-causty, we require some remedy for the 
evil. To most of the batteries, therefore, are attached a pair 



Fig. 49. 




of bellows which can be worked by an assistant. A current 
of air from these passes into the exciting solution of the bat- 
tery, and prevents the accumulation of gas upon the carbon- 
plate. I have used a battery made for me by Mr. Chester, of 
this city, and also a series of twenty Grove's cells, but consider 
the Galvano-Faradic Company's battery much better than either 
of them. 

Mr. Jerome Kidder, of New York, makes a galvano-causty 
battery which Drs. Beard and Eockwell speak very highly of. 

Fig. 50 represents Dr. Byrne's battery. The merits of this 
11 . 



162 



CLINICAL ELECTRO-THERAPEUTICS. 



instrument is its ready portability. As a piece of workman- 
ship it is delicate and beautiful, its great defect being that the 
zinc plates are so very thin that they are rapidly eaten up by 
the solution in which they are immersed. I had the pleasure 



Fig. 50. 




of witnessing the duty this little battery can perform, at a re- 
cent operation by Dr. Sims, at the Woman's Hospital. It 
consists of twelve carbons and twelve zincs, each three by five 
inches, combined and arranged so as to represent four sets or 
cells of three pairs each. In this order the elements are se- 
curely fastened by nuts and screws to a hard-rubber platform 
seven and a half by eight inches in surface, and one-quarter 
inch thick ; and the combinations and connections effected by 
means of narrow strips of copper annealed and nickel-plated. 




Fig. 51.— Dr. Byrne's Galvano-Causty Loop. 



In the centre is a cog-wheel three inches in diameter, which, 
on being turned by means of upright handles, causes the two 
water-agitators to revolve. The object of this arrangement is 

1 All of Dr. Byrne's instruments are made by Messrs. Shepherd & Dudley, N. Y. 



GALVANO-CAUSTY, ETC. 



163 



\ 



u 



w, 



to increase the power of the battery, when, owing to continued 
use, as in tedious operations, the fluid may become exhausted. 

Instruments. — Stohrer, of Dresden, sent to this country the 
first galvano-causty electrodes that were 
used here. Since their arrival, numerous 
improvements have been made. The in- 
struments used may be divided into three 
classes, and these have subdivisions. They 
are : 

1. The loop. 

2. The cauterizing knife. 

3. The porcelain, or dome cautery. 
1. The loop, which is constructed on 

the principle I have alluded to before, is 
simply a piece of fine platinum wire pass- 
ing through supports, and, after being 
doubled, is attached to a non-conducting 
barrel, which is made to revolve at the 
will of the operator, thus shortening its 
length, and finally reducing it altogether, 
if desired. A handle containing an ar- 
rangement for breaking the circuit is ad- 
justed to the supports or tubes through 
which the wires pass. 

Stohrer makes an instrument so cum- 
bersome that it is exceedingly clumsy to 
work with. 1 At my suggestion, Mr. Bart- 
lett, of the Galvano - Faradic Company, 
made me, after a sketch I gave him, an 
electrode which I have used several times 
with success. Its weight is but a few 
ounces, and it is simply and entirely un- 
der the command of the operator, but one 
hand being required for its manipulation. 

Fig. 52 represents the electrode I have Fm 
just mentioned. It consists of a barrel 
regulated by a ratchet ; two tubes, a handle, and a slide for 
breaking the current. The loop of platinum wire passes 

1 Since writing this, I have heard of a most excellent electrode devised by Dr. 
JR. F. Dawson t of this city. 



.—The Author's Galvano- 
Causty Electrode. 



164 



CLINICAL ELECTRO-THERAPEUTICS. 



through these tubes and may be moved upon the barrel, thus 
reducing its diameter. These are made of different shapes ; 
either large, for the greater operations, or long and narrow, for 
the removal of tumors in the larynx, or operations in the vagina. 

2. The cauterizing knife is but a flat plate of platinum, 
which, when incandescent, may be used to divide the soft parts. 
It is also made in many shapes. 

3. The Porcelain, or Dome Cautery. — The spiral adjustment 
of a piece of platinum wire immediately to the surface of a cone 
of thin porcelain will result in the heating of the porcelain by 
the wire when the current is passed. They are of numerous 






Fig. 53. — Various Galvano-Cattsty Electrodes. 
(From a recent article, by Dr. Byrne, in the Medical Record.) 

shapes and sizes, in accordance with the surface of the part to 
be operated upon. The cauterizer may be used in all cases 
when it is our desire to arrest haemorrhage. 

■ In operating, we should first see that our connections are 
all perfect, and that the battery is freshly charged. Then we 
should test the severance power upon a piece of raw meat. If 
the juices of the meat lower the temperature of the wire too 
greatly, a turn or two of the handle which immerses the plates 
will increase the quantity of the current ; when the wire is 
brought to a white, not a red heat (for with the latter the wire 
tears off pieces of tissue, and makes a ragged cut, opening the 
mouths of the vessels, thus producing haemorrhage), we may 
break the current and prepare for the operation in hand. The 
wire should be adjusted about the neck of the tumor, or the 
most convenient place, and, after the wire is wound upon the 
barrel till the part is tightly constricted, the slide is moved and 
the current turned on. Gentle traction is then made, and the 
growth removed. The slide is to be immediately closed, or 



GALVANO-CATJSTY, ETC. 165 

the wire will be melted. Very little after-treatment is to be 
observed. Cold-water dressings, and attention to the patient's 
general condition, are all that are necessary. 

The heat of the wire mnst be ganged to incandescence y and 
the operation quickly performed, otherwise the slow passage 
of the wire through the tissues will produce a diffused inflam- 
mation. When the eschar comes away, we may treat the de- 
nuded surface as we would any other case of simple ulceration. 

The cases I have treated have been of inconsiderable im- 
portance. I append one or two, however : 

I. Dr. Gr. The patient presented himself with a small, hard 
tumor on his right shoulder. After placing a piece of moist- 
ened linen on the part perforated, to permit the exposure of 
the entire tumor, I passed the wire loop about the most con- 
stricted portion, and, after taking the preparatory steps just 
mentioned, I completed the circuit and made gentle traction 
on the wire. In half a minute the growth came away, with- 
out a drop of blood to be seen. The eschar was of an ashy- 
gray color. In a week this eschar became detached, and be- 
neath I found a healthy granulating surface. A few straps, 
and stimulating ointment quickly healed the part. 

II. E. T., aged twenty-five. The patient came to me with a 
small complete fistula, very near the verge of the anus. One 
end of the wire was detached from the barrel and passed by an 
eyed probe through the fistula into the rectum. It was then 
brought down, passed through the tube, and fastened to the 
barrel ; after the loop was tightened, the circuit was closed and 
the tissues divided. The after-management of the case was 
that usually employed in this operation, by the knife. The 
tardy separation of the slough enabled the cavity of the abscess 
to fill up to a great extent before the bare surfaces of the cut 
portion were exposed. Consequently there was not the usual 
disposition of the wound to close by primary adhesion. One ad- 
vantage of this use of the galvano-causty in this case depended 
upon the fact that the patient had a " holy horror " of the knife. 

Dr. A. Murray, of New York, performed the operation upon 
a patient of his in a different way, as the following case will 
show : 

III. In August, 1871, John Connor, who, for nearly eighteen 



166 CLINICAL ELECTKO-THERAPEUTICS. 

months, had been suffering from a fistula in ano, applied to me 
for treatment, requesting a cure if possible without a surgical 
operation. I introduced a small probe of platina wire into the 
fistulous canal, and a wooden scoop into the rectum as a point 
cTwppui for the extremity of the probe. During the operation, 
a galvanic current of sixteen cells, steadily increased, was al- 
lowed to pass for fifteen minutes. The battery having been 
freshly filled that day, the probe became heated so rapidly that 
I was compelled to desist from the application sooner than I 
had wished. However, I was gratified to find that, at the ex- 
piration of live days, the fistula had entirely healed. 

IV. Dr. Corradi 1 lately removed a large tumor (fibrous poly- 
pus) from the pharynx of a man who for a year had been unable 
to pass air through the nostrils. The tumor, when removed, 
measured forty-eight millimetres long, by twenty-eight wide, 
and was of oval form. The base of the tumor adhered to the 
pharynx. The tumor was surrounded by the loop of platinum 
wire fifty-eight centimetres long, the two ends of which were 
brought out of the right nostril. After seeing that the wire 
was closely brought up to the base of the tumor, the two ends 
of it were attached to the extremities of a galvano-caustic ap- 
paratus. The tumor was rapidly cut through, and the patient 
did well. 

The following cures were reported recently by Dr. Thomas 
Bryant, of London : 

Y. Cutaneous JVcevus over Chest. — Alice C, aged four 
months. Naevus involving the skin on the left side of the chest, 
the size of a crown-piece. On January 8, 1869, it was cauterized 
deeply with the porcelain cautery, and brought to a white heat 
by a coil of platinum wire. The whole growth was completely 
destroyed, and in two weeks, when the eschar had separated, 
.perfect cicatrization had taken place. 

VI. Cutaneous JVcevus over Forehead. — Agnes W., aged four 
months. Superficial nsevus over right frontal eminence, the size 
of a shilling. On October 30, 1868, the cautery was freely ap- 
plied, not a stain of blood showing itself. A brown eschar was 
left ; in two weeks this came away, and the parts had healed, a 
perfect and movable cicatrix remaining. 

1 " Lo Sperimentale," 1871. 



GALVANO-CAUSTY, ETC. 167 

VII. Mixed Nawus over Forehead. — Kobert C, aged sixteen 
months. Mixed nsevus, the size of a shilling, on the right 
side of the forehead ; it was very elevated and spongy. Mr. 
Bryant cauterized this superficially, at first turning it into a 
brown eschar, and then puncturing it with another form of 
platinum cautery, the object of this being to destroy the deeper 
parts of the growth. In two weeks the whole dried scab came 
off, and a sound healing surface remained. In another week 
the cure was complete. 

VIII. Spreading Lwpus of the Face, cured by the Cautery. — 
Eliza T., aged thirty, came under Mr. Bryant's care with a spread- 
ing lupus, involving the whole of the nose and upper lip. It 
had existed for four years, and, in spite of all treatment, had 
steadily progressed. On November 6, 1868, it was freely cauter- 
ized. By the 19th the scab was coming away, a healing surface 
remaining. By the 26th the whole eschar had fallen off, and 
the wound was closing. By December 8th the woman was 
well. She was seen on April 10th, when it was difficult to 
make out the seat of the former disease, the cicatrices being so 
indistinct, and the skin natural. 

Dr. Byrne, of Brooklyn, and Dr. Marion Sims, of this city, 
have both operated upon women with galvano-causty in a great 
number of instances with remarkable success. 

Mr. Elliot, 1 of London, gives the operation for prolapsus, as 
follows : " A glass speculum coated with caoutchouc is first 
introduced into the vagina. The os is then cleaned with a 
piece of cotton-wool ; the cautery next heated is allowed to be 
quenched by the diseased tissue, the duration of the applica- 
tion, and the depth of introduction, depending upon the effect 
required. Eschars are easily produced, and the cervix uteri is 
seen to contract under the application of the cautery. 

" It Js never advisable to use a metallic speculum, for the in- 
terior heat is apt to be radiated to such a degree that absolute 
burning of the vaginal walls may ensue. The wax or caoutchouc- 
covered glass ones are the best. Pledgets of wet lint should be 
spread about the exposed surfaces. These simple precautions 
go far to insure the safety of the operation." 

Dr. Byrne, of Brooklyn, gives the following case : 

1 London Lancet, 1853, vol. i. 



168 CLINICAL ELECTRO-THERAPEUTICS. 

IX. Carcinoma of the Uterus, involving both Lower and 
Supra- Vaginal Portions of the Organs. 1 — Mrs. , aged forty- 
seven, the mother of three children, the youngest being ten years 
of age. Since her last confinement, and up to three years ago, 
menstruation has always been regular ; but, about this time, 
symptoms such as usually indicate the approach of the critical 
period of life began to appear. Menstruation became at first 
irregular, but, for over a year, had lost all the character of peri- 
odicity normal to that function, and copious hemorrhages had 
now reduced her to a perfectly helpless condition. By a digital 
examination, the vaginal cervix was found to be hypertrophied 
and irregularly hard to the touch. 

The os uteri admitted, with some difficulty, the index-finger 
to the extent of about half an inch, and the surrounding tissues, 
as far as could be reached, were unyielding and indurated. 
Owing to the peculiar shape of the outgrowth within the va- 
gina, and the absence of any circular line of depression near 
the uteri- vaginal point of convergence, it was very evident that 
the adjustment of an eoraseur cautery loop would be imprac- 
ticable. The difficulty arising from this state of things, though 
not encountered in any of the doctor's previous cases, was, 
nevertheless, provided for. An anaesthetic having been ad- 
ministered, and the patient placed on the table, there was no 
difficulty found in bringing the uterus into such a position 
that full control and ample space were afforded for any manip- 
ulation needed. The gentlemen present at the operation were 
Drs. G-. K. Smith, Skeene, Dwyer, and Bedell. 

The projecting mass was seized by means of a vulsellum 
forceps held in the left hand, while, with a cautery-knife of pe- 
culiar construction, the part so grasped was slowly severed, 
and removed without loss of blood. The same knife, but bent 
in a semicircular form, was now applied to the subjacent struct- 
ures, which were cautiously sliced off, piece by piece, upward 
as well as laterally, to the utmost extent compatible with the 
integrity of the peritoneal surroundings. When the organ was 
thus scooped out, a deep cavity was left, from the bottom of 
which to the fundus measured less than one inch. £To haemor- 
rhage occurred during the whole operation. 

1 American Journal of Obstetrics, August, 1871, p. 296. 



GALYANO-CAUSTY, ETC. 169 

A subsequent examination revealed an utter absence of in- 
durated tissue ; of course, nothing is found resembling a cervix 
or uterus. The vaginal canal terminates in a deep cul^de-sae, 
the interior of which seems to be completely healed and covered 
by a healthy membrane. It is also worthy of notice that in 
the natural process of reparation a good deal of contraction has 
taken place, but the opening is neither puckered, nor does it 
offer the slightest resistance to dilatation by separating the 
blades of a polypus-forceps. The patient has a good appetite, 
is free from pain, and sleeps well. She may be pronounced 
convalescent and out of danger. 

Dr. B. has also operated upon, and satisfactorily removed, a 
very large fibroid polypus in a woman of thirty. It appeared 
the third day -after labor, and, owing to the size and history, 
was at first mistaken for an inverted uterus. The attachment 
was to the posterior lip of the cervix. Removed by the gal- 
vanic loop. He has also removed elongated cervici, cauliflower 
cancer of the uterus, etc., etc. 

In numerous minor operations it has been successful in my 
hands. I have, on more than one occasion, stopped obstinate 
haemorrhage following the use of the knife. 

Dr. Whittaker, of Cincinnati, contributes the following case 
to The Clinic : ' 

X. Amputation of the Cervix. — Mrs. B., aged twenty-eight, 
is still sterile, though married for several years and in fair physi- 
cal condition. She has suffered with menstrual irregularities 
ever since marriage ; dysmenorrhoeal at times, in character, at 
times amenorrhoeal, at times menorrhagic. She is of hysteric 
temperament. There are cervical hyperplasia to the extent of 
one inch ; anteflexion, with pressure upon the bladder, and im- 
permeability to the entrance of even the finest sound. 

I proposed first to remove part of the cervix, subsequently 
to dilate and explore the uterine cavity. 

Accordingly, she took rooms in the Hospital of the Good 
Samaritan, where the operation of amputation of the cervix by 
galvano-causty was undertaken the following day. She insist- 
ed upon chloroform, which we were compelled to administer. 
Having placed her in Sims' s position, and brought her lightly 

1 The Clinic, September, 1872. 



170 CLINICAL ELECTRO-THERAPEUTICS. 

under the influence of chloroform, a hard-rubber speculum was 
introduced, and the elongated cervix invaginated into its upper 
extremity. 

The apparatus having been prepared and tested upon a 
piece of meat by my friend and colleague Prof. Seely, with 
the assistance of Drs. Jones and Lockhart, house-physicians, 
in keeping the patient steady — all the assistance required — I 
slipped the noose over the cervix with the greatest ease, adjust- 
ed it smoothly about it, probably half an inch from its extrem- 
ity, screwed the wire home and then touched the spring of con- 
nection with the battery. The progress of the wire, as it slowly 
tightened under the screw, was evidenced also by the sound, 
smoke, and savor of the cuisine from the rapidly-burning tis- 
sue. In perhaps one minute the operation was complete, and 
the ring of detached cervix fell from the tube. The uterine 
surface — the stump, so to speak — was perfectly white and clean. 
There escaped throughout, nor afterward, no single drop of 
blood. I then inserted a sponge-tent forthwith, which I was 
obliged to remove on the following day, however, on account 
of the supervention of the menses. Menstruation continued 
rather profuse for several days, yielding only finally to large 
doses of ergot. She had, during this period, suffered the usual 
pains. I was about to resume efforts at dilatation after the 
discharge had ceased, but the patient had already wearied of 
treatment, and left the house. 

It was a matter of regret, of course, not to have been able 
to have followed up the case as I had proposed, but I was 
thankful for the opportunity of personal experience with the 
galvano-causty noose. It is an instrument which filled all the 
requirements in this case. I have since heard, indirectly, that 
the patient is doing well. 

AMPUTATION OF THE PENIS. 1 

In Langenbeck's "Archiv," M. Zielewicz mentions fifty 
cases where the penis was operated on by a wire heated by 
galvanism. For the most, it was for carcinoma the operation 
was made use of. In one case there was a considerable papil- 
lary tumor, and in another gangrene. Eight of the fifty cases 

1 Reported in The Doctor, November 1, 1871. 



GALVANO-CAUSTY, ETC. 171 

died of pyaemia ; all of them were hospital cases. No haemor- 
rhage took place in any of the cases, nor was there ever any 
traumatic fever. The contraction after the operation, of the 
urethral orifice, was similar to what takes place after the knife. 
The ages of those operated on were known in forty-five cases. 
It was in one under 20 ; in six, between 30 and 40 ; in fifteen, 
between 40 and 50 ; in fifteen, between 50 and 60 ; and in seven 
between 60 and 70. Three cases occurred in old men between 
70 and 80. 

GALVANO-CAUSTY IN HEMORRHOIDS. 

M. Yerneuil, at the Lariboisiere, has treated haemorrhoids 
by running through them the electric-cautery needle at a dull- 
red heat, which obliterates the vessels without setting up active 
inflammation beyond. Atrophy follows. I myself have treat- 
ed two or more cases in this way, when the haemorrhoids were 
not aggravated. In another I removed a large mass of haem- 
orrhoids by the loop, without any inconvenience to the patient 
or any bleeding. It is well, in this operation, to protect the 
surrounding soft parts well with cotton saturated with water, 
and, after the parts to be removed are exposed, they should be 
quickly divided. 

ELECTRO-CHEMICAL BATHS. 

Several writers, among them Caplin, Meding, and M. Cha- 
pot-Duvert, have used the electro-chemical baths for the pur- 
pose of extracting metallic substances from the body. Yer- 
ques 1 reports an interesting evidence of its virtue in extracting 
metals from his own body ; and lately Dr. Murray, 2 of New 
York, has given his results in a number of the New York 
Medical Journal. Althaus 3 rather doubts its efficacy, and has 
but little faith in it. In rheumatism it is indicated, perhaps, 
but even then it would do more good if the electricity were ap- 
plied locally and concentrated. The benefit it has as a general 
cutaneous stimulant cannot be denied, and therefore it is clear- 
ly indicated. M. Camille Chapot-Duvert describes 4 his appa- 

1 Meyer's " Medical Electricity," p. 489. 

3 New York Medical Journal, November, 1872. 
8 " Medical Electricity," p. 658. 

4 London Practitioner, August, 1871, p. 115. 



172 CLINICAL ELECTRO-THERAPEUTICS. 

ratus thus : " It consists of a pair of Bunsen's elements of 
medium size, and a coil of large wire connected with a copper 
regulator which augments or diminishes the force of the appa- 
ratus by covering or uncovering a larger or smaller portion of 
the core, which serves to interrupt the current by means of a 
vibrator. The positive pole, formed of a large fragment of 
charcoal, corresponds to the pedal, and the negative, formed of 
a plate of zinc, to the cephalic extremity." We can modify 
this cumbersome apparatus by simply connecting an ordinary 
faradic instrument with two plates of metal ; these are im- 
mersed in the bath, which should be made of varnished pine. 
The secondary current must be used. We employ this bath in 
cases of prolonged debauch, for the extraction of lead and oth- 
er metals, and for mercurial trembling. " Mercurial tremor," 
Dr. Duvert says, 1 "is one of the most frequent manifestations 
of mercurial intoxication. Without causing any apprehension 
in respect to the life of the sufferer, it is a troublesome symp- 
tom for the workman who is obliged to gain his livelihood by 
the labor of his hands. The progress of the disease is slow, 
and it recurs frequently if the individual be exposed anew to 
the original cause of the affection. The measures usually em- 
ployed consist in sudorifics, vapor and sulphur baths. Opium 
has also been recommended, but the treatment has always been 
excessively protracted, and has often proved unsuccessful. A 
mirror-maker, aged twenty-six, applied on the 12th of January, 
1870, at the Hopital St.-Louis ; brought up as an agriculturist, 
he had been five years at the trade. Soon after commencing 
to work at it, he had the usual symptoms of mercurial] sm, but 
these were removed by treatment, and he remained well for 
two years. He then suffered a relapse, and was again cured. 
He was abstemious in regard to drink, and went on tolerably 
well to December, 1869. Then debility was experienced, fol- 
lowed by gradually-increasing tremor, for the relief of which 
ne applied. The trembling was marked in both pairs of ex- 
tremities, sensibility was intact, the muscular force was consid- 
erable. He was placed in the electric bath, and remained in it 
for twenty minutes, and this was repeated daily for seven days. 
Great improvement in the power of walking was experienced, 

1 Bulletin GSneral de Therapeuiique, June 15, 1871. 



ETC. 1^3 

and lie could use his right hand to eat with. After twelve 
days' baths, the improvement was still more marked ; he could 
run with facility and walk with an assured step, though on his 
admission he was so weak he could scarcely stand upright. 
After twenty baths he was perfectly well." M. Chapot-t)uvert 
states that he has had equal success with the remedy in cases 
of alcoholic tremor. He was unable to discover that any traces 
of the metal in the former cases were discharged either by the 
urine or on the zinc plate. 

Dr. Duvert " reports other cases, one of which was a con- 
firmed drunkard. He could not stand, from sheer exhaustion. 
He remained in the bath twenty minutes, and after seven baths 
the case was cured. 

Mr. S. Eussell, Jr., of this city, has constructed a very 
useful galvanic bath, which may be seen in Fig. 54. It is 
claimed by the inventor that medical solutions may be intro- 
duced into the system by this arrangement. The currents can 
be localized by means of the perforated diaphragm therein. By 
the electrode E the current may be diffused. An external bat- 
tery of several large Smee or Daniell cells furnishes the current. 




Fig. 54.— Electbo-Medioal Bath. 

A, Tub. D. Foot-rest. 

B, Diaphragm. E. Hinged Electrode. 

C, Electrode. F F, Binding-Screws. 

b, Slide. 



THE ABSORPTION OF INFLAMMATORY PRODUCTS. 

Dr. Ludwig Seeger 2 gives several cases, where he produced 
absorption of inflammatory swellings by putting the positive 
pole on the plexus from which the affected part received its 

1 Memorabilien, July, 18*72. 2 Vienna Medical Presse. 



174 CLINICAL ELECTRO-THERAPEUTICS. 

nervous supply. The negative pole, connected with the brousse 
elecfirique, was applied to the tumor. 

Two cases are given in point : I. A young woman, aged 
twenty-two, was taken sick a few days after confinement, with 
acute pain in the hypogastrium, and shortly afterward appeared 
a hard, painful swelling, of the size of an egg, near the left 
abdominal ring. Urine rich in albumen. Diagnosis : perime- 
tritis cum albuminuria inpuerpera. Notwithstanding the suc- 
cessive use of cold, cataplasm, quinine, iron, iodid. potass., no 
change for the better appeared in the exudation. At the time 
the electricity was first applied, the tumor extended from the 
mons veneris, and along Poupart's ligament, obliquely upward, 
outward, and backward, to under the quadratus lumborum mus- 
cle. Skin transparent, and in spots reddened, with scarcely 
any elevation in temperature. Thigh flexed on the body at an 
angle of 45°, and allowing of no motion. 

The galvanic current was applied every two days, the posi- 
tive pole over the spinal column and sympathetic, and the 
negative over the tumor. At the same time patient took infus. 
cinchona. After third application pain diminished; patient 
able to turn, by her own strength, on her left side. 

Fifteenth application : exudation markedly diminished ; 
patient able to sit up. Thirtieth application : no albumen 
in urine; is able to go about with crutches, and move her 
limb quite freely. Fortieth application: exudation not visi- 
ble ; on firm pressure, has a little dull pain ; patient goes about 
without support. Fifty-second application: girl completely 
cured. 

II. F. K., aged seventeen. After a severe attack of scarlet 
fever, followed by pneumonia, complained of pain on urinating, 
and, at the same time, there appeared in the perinseum and 
along the course of the urethra a painful elastic swelling ; ten 
days after, complained of tension and pain on the inner side 
of the right thigh, and, at the same time, great sensitiveness 
of the scrotum, and inflammation of the superficial and deep 
inguinal glands. As the pain and swelling in the inguinal 
region increased, the swelling on perinseum and scrotum disap- 
peared. At first, cold applications were used. Patient became 
reduced in strength and flesh ; fever ; pulse 120. Purp. ferri 



GALVANO-CAUSTY, ETC. 175 

iodid., with aq. laur.-ceras., was given, and iodid. potass, and 
glycerine for several weeks rubbed over the part. At the time 
galvanism was first applied, the patient was in the following 
condition : Pulse 90 ; a hard, painful, immovable tumor on the 
inner side of the right thigh, extending to the middle of the 
anterior surface of the thigh ; skin over the tumor not abnor- 
mal ; temperature slightly elevated ; circumference of diseased 
limb nine centimetres greater than the unaffected. Active move- 
ment of the limb impossible ; with passive movements the pelvis 
also moves with it. Positive pole applied on spinal column, and 
negative with metallic brush electrode over the tumor, as in 
the former case. After the tenth application, the circumference 
of thigh diminished three centimetres, and the tumor iiYe 
centimetres in length ; patient feels much better, and has more 
command of his movements. Twentieth application, size of 
tumor much reduced, patient able to go about room without 
crutches. Twenty-ninth application, swelling no more visible, 
patient able to go about without crutches ; feels strong and well, 
and dismissed as healed. Patient was seven weeks under treat- 
ment with electricity. 



SPERMATORRHEA AND IMPOTENCY. 

Electricity has been so extensively used by quacks in this 
country, that I hesitate upon entering into a description of its 
merits, as these very persons have so depraved electro- thera- 
peutics. The counter-irritation effected in the deeper portion 
of the urethra, and the stimulation of the muscular fibres sur- 
rounding the apertures of the various ducts, result in cure. 

. In impotency, a judicious use of the faradic and galvanic 
currents will give tone to the genital organs, and when erectile 
power is lost will restore it. The faradic current must be ap- 
plied to the genital parts, to the muscles concerned in erection, 
the scrotum, and to the skin if anaesthesia exists. 

In impotency resulting from the excessive use of narcotics, 
or from constitutional disease, we are to galvanize the cord. 
In those cases where virile power is lost from locomotor ataxia 
or other spinal disease, it is invaluable. 



176 CLINICAL ELECTRO-THERAPEUTICS. 

ELECTRICITY IN ORTHOPRAXY. 

Drs. Lewis Sayre and Le Roy M. Yale have used it as an 
adjuvant to other remedies in many of the cases of talipes they 
have treated. Dr. Fisher, a distinguished specialist in orthope- 
dics, whose position as a physician to the New York Orthopedic 
Dispensary enables him to see many cases of deformity, speaks 
most confidently of both galvanism and faradism, and has been 
kind enough to give the report of a striking case, which will con- 
vince the reader of the value of the electric treatment. In nearly 
all of the orthopedic diseases there is more or less paralysis and 
atrophy. In morbus coxarius, during the later stages, where 
there are resisting contraction of the muscles and anchylosis, 
galvanism may be suggested. In the atrophy of muscular tis- 
sue that exists, faradization will also give good results. 

Dr. Fisher's case is as follows : 

A. C, aged twelve and a half years, presented himself, on 
March 11, 1872, at the New York Orthopedic Dispensary, 
with paralysis of the right upper extremity. His father, who 
accompanied him, gave the following history of his case : He 
was healthy up to the age of seven months, when he was seized 
with fits of screaming at night, as if from great pain, without 
any ascertainable cause. During the day he appeared to be as 
well as usual. These attacks of crying continued nightly for about 
three weeks, and then his parents noticed that the right side 
of the body, including the face, was paralyzed. The inability 
remained complete for two months, after which an improve- 
ment began to show itself in the face and lower extremity, and 
continued to increase ; so that, when he was about two years 
and a half old, the motility of both was entirely restored. IJut 
the right upper extremity remained completely useless, and 
became an encumbrance, as well as a source of considerable 
pain and distress. When the palsy was discovered, twelve 
years ago, the parents took the boy to Prof. Yalentine Mott's 
clinique at the Medical Department of the New York Univer- 
sity, and were there advised to resort to no treatment, but to 
keep the patient out of the hands of doctors. This counsel 
had been scrupulously adhered to up to the time of his applica- 
tion for treatment at the Orthopedic Dispensary. 



GALVANO-CAUSTY, ETC. 177 

On the examination, A. C. appeared to be a well-grown and 
fairly-nourished boy, though rather dull of intellect. There 
was no trace remaining of facial palsy, nor was there any dif- 
ference noticeable between the two lower extremities, except 
that the right foot was a little smaller than the left. The right 
upper extremity was cold and lifeless, hanging helplessly by 
the side. It was two inches and a quarter shorter than the 
left, and the atrophy of bone and muscle was extreme. A 
marked difference between the two sides was apparent in the 
clavicle, scapula, and ribs, arising chiefly, no doubt, from the 
absence of that natural stimulus to growth which voluntary 
movement would have developed. A paralysis which had oc- 
curred during infancy, and existed for so many years without 
treatment, had of necessity resulted in deformity. The capsu- 
lar ligament, and the tendons which reenforced it, had yielded 
to the steady traction of the weight of the limb, and the head 
of the humerus was dragged downward from the glenoid cavity, 
giving rise to considerable pain and discomfort. The hand 
presented the most serious deformities. At the wrist it turned 
strongly outward, so as to be at a right angle with the line of 
the bones of the forearm. The thumb hung semi-extended 
with marked atrophy of the thenar muscles. At the metacarpo- 
phalangeal articulations there were subluxations toward the 
palmar surface, so that in lieu of knuckles there were four deep 
dimples. The middle, ring, and little fingers, had undergone a 
partial rotation on their long axes and lay heaped up ; the pal- 
mar surface of each resting on the dorsum of the one preceding 
it. The pectoral muscles and the deltoid could not be distin- 
guished by manipulation. The muscles of the arm were en- 
tirely powerless, and so much atrophied that they could with 
difficulty be made out. The forearm was in nearly as bad a 
condition, but the patient had the power of moving slightly 
the middle, ring, and little fingers. There were no contrac- 
tions produced by the faradic current in any of the muscles 
of the limb, but the trapezius, latissimus dorsi, levator anguli 
scapulse, rhomboidei, and serratus magnus muscles, reacted dis- 
tinctly to it. The galvanic nerve-muscle current, interrupted, 
produced contractions throughout the arm and forearm, but 
more markedly in the muscles of the latter than in those of the 
12 



178 CLINICAL ELECTRO-THERAPEUTICS. 

former. Tlie deltoid and pectoral muscles were so much atro- 
phied that the existence of contractile fibres could not be veri- 
fied by the test of electricity, though the patient thought 
he could perceive a contraction in the latter when they were 
brought under the action of the galvanic current. 

The electrical treatment of this case commenced with the use 
of the galvanic cord, plexus, and muscle currents interrupted, 
and in labile * applications down the arm. Improvement was 
immediate in the nutrition of the member, and, as a conse- 
quence, the numbness, pain, and other sensations of discomfort, 
which the patient had experienced for years, in varying sever- 
ity, were considerably assuaged. Within the first week he was 
able to move slightly the forefinger, over which he had had no 
control for twelve years, and, at the beginning of the third 
week of the treatment, the muscles of the forearm reacted to the 
faradic current. After ten weeks of treatment the hair began 
to grow vigorously on the arm and shoulder, and the finger- 
nails required cutting more frequently than before. The dura- 
tion of the applications of electricity was very brief, at first, 
in order that the feeble muscles might not be overtaxed. 

Improvement has continued slowly and steadily, until, by 
degrees, all the muscles have come under the control of the 
faradic current. Galvanization has, therefore, given place to 
the latter in great measure, though it has been employed 
throughout for its stimulant effects upon the processes of nutri- 
tion and growth. There has been an average increase of one- 
third in the circumference of the limb, and now, after a year's 
treatment, instead of an utterly powerless arm, which dangled 
as an impediment by his side, the patient is able to pronate 
and supinate, to Rex and extend the forearm, to swing the 
whole limb forward and backward, and to circumduct it with 
considerable force. He can carry the right hand to the left 
shoulder, and then elevate and depress the elbow, and, when 
the right hand is placed on his head, he can hold it there in 
position. There has been great improvement in the condition 
of the hand, although not yet sufficient to render it of much 
use. The thumb still remains beyond the control of the will, 

1 Stable and labile are terms used to designate that both electrodes were held 
stationary, or that one or both are moved over the surface of the body. 



GALVANO-CAUSTY, ETC. 179 

notwithstanding a very decided increase in the growth of its 
proper muscles. But the chief cause of inability lies in the 
character of the deformities of the fingers, which prevent the 
patient from using, to the greatest advantage, that muscular 
power which he has already gained. By the aid of a mechanical 
contrivance, the distorted joints are being slowly restored to 
their proper positions, and, as progress and growth in develop- 
ment are still advancing, there are strong hopes that, eventual- 
ly, he will recover the use of quite a serviceable limb. During 
the year there have been two interruptions in treatment : one 
in April and May, of twenty-six days ; the other in August, 
September, and October, of eighty-one days. There were sev- 
enty-two applications of electricity made during the remaining 
time — on an average of about twice a week. The boy's father 
was directed in the beginning to keep his son's arm well pro- 
tected from cold, and to rub it vigorously twice a day at home, 
which directions were faithfully performed during the first 
three months. Frictions, kneadings, active and passive move- 
ments have been used as adjuvants to the treatment at the dis- 
pensary. Although these were of undoubted value in promoting 
the present degree of restitution of function, yet the main reli- 
ance in the treatment of this case has been placed in electricity. 

Dr. Whittaker reports the following case of talipes : 1 

A. S., aged three, was brought to the clinic about June 1st. 
She is a hale, handsome child, which makes the deformity more 
than usually apparent. The talipes is of the valgus type, in the 
first stage, the flexors lacking tone, as also the triceps sural, for 
there is difficulty in lifting the foot from the ground. This 
gives a peculiarity to the gait, whereby the foot is dragged to 
the front with out-turned toes, somewhat as in the hemiplegic, 
but without the rotatory swing. 

Treatment was commenced June 2d. No appliances of any 
kind were used, that the result might not be clouded by com- 
plications. 

The application was exceedingly simple ; the positive elec- 
trode, a disk of carbon covered with thick sheep-skin and moist- 
ened, was applied to the ham, and afterward to the inner aspect 
of the knee-joint, over the point designated by Morgan as the 

1 The Clinic 



180 CLINICAL ELECTRO-THERAPEUTICS. 

surface of application for galvanization of the internal portion 
of the gastrocnemius, soleus, and flexors of the toes, while the 
negative was stroked along the inner ankle and the inner bor- 
der of the plantar surface of the foot. Galvanization (eighteen 
cups) was always continued until decided redness was manifest 
and sensation of burning was experienced. This usually oc- 
curred in about three minutes. Sessions were repeated regu- 
larly three times a week. 

At the end of three weeks the efficacy of treatment began 
to appear, less in relief of the deformity, than in the greater 
ease and alacrity of elevating the heel. At the end of four 
weeks deformity was only evident when the child was shod; 
in bare feet, there was no difference whatever in the two sides. 
In two more sessions (August 8th) there was no deformity 
whatever, and no difference perceptible in shoes. 1 



MISCELLANEOUS THERAPEUTICAL USES OF ELECTRICITY. 

For the Detection of Metallic Bodies. — M. Favre, of Mar- 
seilles, has invented a little instrument for detecting the pres- 
ence of bullets or other missiles in the human body. A probe 
is inserted into the wound, the extremity of which contains the 
ends of two wires from the battery. When this probe strikes 
the metallic body, the circuit is closed, and by an ingenious 
combination of hammer and magnet a bell is rung. By means 
of the magnet it is often possible to detect the presence of for- 
eign bodies of a metallic character that may be embedded near 
the surface. An electro-magnet, with a very powerful current, 
will often remove a needle, even if it be located at some depth. 

Carbuncles and furuncles may be dissipated in their early 
stages by applying to them the negative pole of the galvanic 
current, and the positive pole to some neighboring part. 

Vomiting of Pregnancy. — Dr. S. Iffla presented a memoir 
to the Medical Association of Yictoria (Australia), communi- 
cating the great value of electricity in cases of obstinate vomit- 
ing of pregnancy. In one remarkable case, defiant of all medi- 

1 In the application of galvanism, contractions may appear, and, after a while, 
cease. The cause for this is, that the muscular irritability is overpowered by too 
strong a current. 



GALVANO-CAUSTY, ETC. 181 

cation, where the patient was reduced to the last degree, prompt 
recovery followed the application of the constant current to the 
epigastric region. A recurrence of the same difficulty in the 
same case in a subsequent pregnancy as promptly yielded a 
second time to the same means. 

There are a great many other conditions for which elec- 
tricity is recommended by various authors. I will simply say, 
in conclusion, that the study of electro-physiology, and the 
good judgment of the physician, will govern him in the treat- 
ment of those diseases I have not alluded to in this volume. 



APPENDIX. 

Management of Batteries. — Solutions for Batteries. — Insulation of Needles. — Gal- 
vano-Causty Apparatus, etc., etc. 

Many practitioners have been troubled in their manage- 
ment of electrical apparatus simply because they have not taken 
certain simple precautions which were necessary. It is impor- 
tant to keep all the connections of a battery free from the prod- 
ucts of oxidation ; to have the battery solutions fresh, and of 
requisite strength ; to remove the plates from the battery solu- 
tion after use, if possible, and to have all thumb-screws tight. 
The battery-cords, for the convenience of the operator, in most 
of the machines are colored red and green. The green cord is 
that to be affixed to the negative pole, and the red to the posi- 
tive. This arrangement enables the practitioner to distinguish 
the pole without consulting the battery itself during the seance. 

"When the external coil of wire in the induction machine 
is drawn out, the force of the primary induced current is in- 
creased. When the polarity is changed by the apparatus for 
that purpose, pushing in the external coil (covering the bundle 
of wires) will increase the secondary current. 1 

BATTERY SOLUTIONS. 

For Grenet's, Bunsen's, Stohrer's, and the cups of the gal- 
vano-causty and G-alvano-Faradic Company's batteries, the so- 
lution should be prepared as follows : 

Potassa bichromate (pulverized) § viij. 

Cold water Ov. 

Sulphuric acid § vij. 

First dissolve the bichromate of potassa in the cold water, 
and, when entirely dissolved, add the sulphuric acid slowly. 

1 Different instruments have various devices for accomplishing this. 



APPENDIX. ' 183 

If the cells are not readily removable from the batteries, 
a large bard-rubber syringe may be used for withdrawing the 
old battery-fluid and refilling with the new. 

Solution for Smee's, Kidder's, and Curt Meyer's batteries : 

Sulphuric acid § j.- § iij. 

Water Oj. 

M. 

These should be cautiously mixed, as the heat produced by 
their sudden, union is very apt to break the glass vessel in 
which they are contained. 

For Hammond's modification of Hill's battery : Prepare a 
solution of sulphate of zinc, one pound and a quarter to each 
cell. Pour it in, filling the cell a little above the level of the 
upper surface of the zinc. Drop to the bottom, through the 
opening in the zinc, a few crystals of sulphate of copper. There 
is copper in the bottom of the cell immersed in a solution of 
sulphate of copper, forming a blue liquid. Zinc suspended 
above, immersed in a white liquid, a solution of sulphate of 
zinc. The darker part below represents the solution of cop- 
per ; the lighter above, that of zinc. 

Care of the Battery. — The blue solution should remain at 
the bottom, and only there. Therefore it must not be dis- 
turbed, or mixed with the other. Sulphate of copper is the 
nutriment of the battery, and is constantly being consumed. 
A few crystals require to be dropped in every two or three days. 
Keep the zinc clean. "When its lower surface becomes incrust- 
ed, remove it carefully from the cell and scrape off the deposit. 
It will not require to be cleaned oftener than once in two or 
three months. As the zinc dissolves it loads the solution with 
sulphate of zinc, and in time this becomes saturated. Test it 
with the hydrometer. If it rises to 40°, remove about a tea- 
cupful of the fluid and replace it with fresh water. This can 
easily be effected by a battery-pump, a siphon, or a flexible 
tube. The water lost by evaporation must also be resupplied. 
Evaporation may to a great extent be prevented by pouring 
paraflme on the liquid, say to a depth of about half an inch. 
Remove the crystals that will form on the sides of the cell, 
above the surface of the liquid, by wetting the fingers with 



184 APPENDIX. 

fresh water, and pushing them down. Above all, avoid mix- 
ing the two solutions. 

In Smee's and other batteries, when sulphuric acid and 
water are used, it is well to put a teaspoonful of mercury into 
the cell ; this keeps the plates amalgamated. 

In all batteries, when carbon plates are used, it is well oc- 
casionally to remove and allow them to soak for several days in 
pure water, occasionally changing the same. The salts which 
collect in the substance of the porous carbon will, unless this is 
done, greatly interfere with the strength of the current. 



CATALOGUE 

OP 

MEDICAL WORKS. 



ANSTTE. 

JN euralgia, and Diseases which resemble it. 
By FRANCIS E. ANSTIE, M. D., F. E. C. P., 

Senior Assistant Physician to Westminster Hospital ; Lecturer on Materia Medica in West- 
minster Hospital School ; and Physician to the Belgrave Hospital for Children : Editor 
of "The Practitioner" (London)," etc. 

1 vol., 12mo. Cloth, $2.50. 

" It is a valuable contribution to scientific medicine."— The Lancet (London). 

"His work upon Neuralgia is one of the most interesting, instructive, and practical, 
we have seen for a long time. We have given it careful reading and thoughtful study, 
and, for a treatise of its size, we are free to say that we have never met one that gives 
more practical information and is fuller of useful suggestions." — Medical Record. 

BARKER 
On Sea-sickness. 

By FORDYCE BARKER, M. D., 

Clinical Professor of Midwifery and the Diseases of Women in the Bellevue Hospital 
Medical College, etc. 

1 vol., 16mo. 36 pp. Flexible Cloth, 75 cents. 

Reprinted from the New York Medical Journal. By reason of the great demand 
for the number of that journal containing the paper, it is now presented in book form, 
with such prescriptions added as the author has found useful in relieving the suffering 
from sea-sickness. 

BARNES. 

Obstetric Operations, including the Treatment 

of Haemorrhage. 

By ROBERT BARNES, M. D., F. R. C. P., London, 

Obstetric Physician to and Lecturer on Midwifery and the Diseases of Women and Chil- 
dren at St. Thomas's Hospital; Examiner on Midwifery to the Royal College of Phy- 
sicians and to the Royal College of Surgeons; formerly Obstetric Physician to the 
London Hospital, and late Physician to the Eastern Division of the Royal Maternity 
Charity. 

WITH ADDITIONS, by BENJAMIN F. DAWSON, M. D., 

Late Lecturer on Uterine Pathology in the Medical Department of the University of New 
York ; Assistant to the Clinical Professor of Diseases of Children in the College of 
Physicians and Surgeons. New York; Physician for the Diseases of Children to the 
New York Dispensary ; Member of the .New York Obstetrical Society, of the Medical 
Society of the County of New York, etc., etc. 

Second American Edition. 1 vol., 8vo. 503 pp. Cloth, $4.50. 

To the student and practitioner this work will prove of the greatest value, being, as it 
is, a most perfect text-book on " Obstetric Operations," by one who has fairly earned the 
right to assume the position of a teacher. 

" Such a work as Dr. Barnes's was greatly needed. It is calculated to elevate the 
practice of the obstetric art in this country, and to be of great service to the practitioner.'' 
— Lancet. 



D. Appleton & Co.'s Medical Publications. 

Bellevue and Charity Hospital Reports. 

The volume of BelUvue and Charity Hospital Reports 
for 1870, containing valuable contributions from 

ISAAC E. TAYLOK, M. D n WILLIAM A. HAMMOND, M. IX, 

AUSTIN FLINT, M. D., T. GAILLARD THOMAS, M. D., 

I^EWIS A. SAYRE, M. D., FRANK H. HAMILTON, M. D., 

and others. 

1 vol., 8vo. Cloth, -84.00. 

44 These institutions are the most important, as regards accommodations for 
patients and variety of cases treated, of any on this continent, and are surpassed 
by but few in the world. The gentlemen connected with them are acknowledged 
to be among the first in their profession, and the volume is an important addition, 
to the professional literature of this country. ' r — PsychologicalJonrnal 



BENNET 
Winter and Spring on the Shores of 

the Mediterranean; or, the Riviera, Mentone, Raly, 
Corsica, Sicily, Algeria, Spain, and Biarritz, as Win- 
ter Climates. 

By J. HENRY BEXNET, M. D., 

Member of the Royal College of Physicians, London; late Physician-Acconcher to the 
Royal Free Hospital; Doctor of Medicine of the University of Paris; formerly Resi- 
dent Physician to the Paris Hospitals (ex-Interne des Hopitaux de Paris), etc 

This work embodies the experience of ten winters and springs passed by Dr. Bennei 
on the shores of the Mediterranean, and contains much valuable information for physi- 
cians in relation to the health-restoring climate of the regions described. 

1 vol., 12mo. 621 pp. Cloth, $3.50. 

" Exceedingly readable, apart from its special purposes, and well illustrated,"— Even- 
ing Commercial. , , 

"It has a more substantial value for the physician, perhaps, than for any other class or 
profession. . . . We commend this book to our readers as a volume presenting two 
capital qualifications— it is at once entertaining and instructive.' —N. Y. Medical Journal. 

On the Treatment of Pulmonary Con- 

sumption, by Hygiene, Climate, and Medicine, in its 
Connection with Modern Doctrines. 

By JAMES HENRY BENNET, M. D., 
Member of the Royal College of Physicians, London; Doctor of Medicine of the University 

of Paris, etc., etc. 

1 vol., thin 8vo. Cloth, $1.50. 

An interesting and instructive work, written in the strong, clear, and lucid manner 
which, appears in all the contributions of Dr. Bennet to medical or general literature. 

"We cordially commend this book to the attention of all, for its practical common- 
eense views of the nature and treatment of the scourge of all temperate climates, pulmo- 
nary consumption."— Zteirca Review of Medicine. 



D. Appleton & CoSs Medical Publications. 

BILLROTH. 
General Surgical Pathology and Th$- 

rapeuties, in Fifty Lectures. A Textbook for Students 
and Physicians. 

By Dr. THEODOR BILLROTH, 

Professor of Surgery In Vienna. 

Translated from $he Fourth German Edition, with the special permission 
of the Author, by 

CHARLES E. HACKLEY, A. M., M. D., 

8orgeon to the Now York Eye and Ear Infirmary; Physician to the New York Hospital; Fellow 
of the New York Academy of Medicine, etc 

1 vol., 8Vo. 676 pp.) and 153 Woodcuts, Cloth, $5.00. 

Professor Theodor Billroth, one of the moat noted authorities on 
Surgical Pathology, gives in this volume a complete resume of the exist- 
ing state of knowledge in this branch of medical science. The fact of 
this publication going through four editions in Germany, and having 
been translated into French, Italian, Russian, and Hungarian, should be 
some guarantee for its standing. 



SPECQIEK OF ILU78TBATI0N8, 




Mammary Cancer, acinous form, magnified 50 diameters. 

" The want of a book in the English language, presenting in a concise form the 
views of the German pathologists, has long been felt ; and we venture to say no 

book could more perfectly supply that want than the present volume 

We would strongly recommend it to all who take any interest in the progress of 
thought and observation in surgical pathology and surgery." — The Lancet. 

" A great addition to our literature." — N. Y. Medical Journal. 

" We can assure our readers that they will consider neither money wasted in 
its purchase, nor time in its perusaL" — The Medical Tuvesiigator. 



D. Applet on & CoSs Medical Publications. 

COMBE. 

The Management of Infancy, Physiologi- 
cal and Moral. Intended chiefly for the Use of 
Parents. 

By ANDREW COMBE, M. D. 

REVISED AND EDITED 

By SIR JAMES CLARK, K.C.B., M. D., F.R.S., 

Physician-in-ordinary to the Queen. 

First American from the Tenth London Edition. 1 vol., 12mo. 302 pp. 

Cloth, $1.50. 

" In the following pages I have addressed myself chiefly to parents 
and to the younger members of the medical profession ; but it is not to 
them alone that the subject ought to prove attractive. The study of in- 
fancy, considered even as an element in the history and philosophy of 
man, abounds in interest, and is fertile in truths of the highest practical 
value and importance." — Extract from Author's Preface. 

" This excellent little book should be in the hand of every mother of a family ; 
and if some of our lady friends would master its contents, and either bring up 
their children by the light of its teachings, or communicate the truths it contains 
to the poor by whom they are surrounded, we are convinced that they would ef- 
fect infinitely more good than by the distribution of any number of tracts what- 
ever .... We consider this work to be one of the few popular medical treatises 
that any practitioner may recommend to his patients ; and, though, if its precepts 
are followed, he will probably lose a few guineas, he will not begrudge them if 
he sees his friends' children grow up healthy, active, strong, and both mentally 
and physically capable." — The Lancet 

DAVIS. 

Conservative Surgery, as exhibited in remedying 
some of the Mechanical Causes that operate injuri- 
ously both in Health and Disease. With Illustrations. 
By HENRY G. DAYIS, M. D., 

Member of tne American Medical Association, etc., etc. 

1 vol., 8vo. 315 pp. Cloth, $3.00. 

The Author has enjoyed rare facilities for the study and treatment 
of certain classes of disease, and the records here presented to the pro- 
fession are the gradual accumulation of over thirty years' investigation. 

• " Dr. Davis, bringing, as he does to his specialty, a great aptitude for the 
solution of mechanical problems, takes a high rank as an orthopedic surgeon, 
and his very practical contribution to the literature of the subject is both valu- 
able and opportune. We deem it worthy of a place in every physician's library. 
The style is unpretending, but trenchant, graphic, and, best of all, quite intelli- 
gible." — Medical Record. 



D. Appleton <Sb Co?s Medical Publications. 

FLINT. 

The Physiology Of Man. Designed to rep- 
resent the Existing State of Physiological Science as 
applied to the Functions of the Human Body. 
By AUSTIN FLINT, Jb., M. D., 

Professor of Physiology and Microscopy in the Bellevne Hospital Medical College, and in the 
Long Island College Hospital; Fellow of the New York Academy of Medicine; Microscopist 
to Bellevue Hospital. 

In Five Volumes. 8vo. Tinted Paper. 
Volume I. — The Blood ; Circulation ; Respiration. 

8vo. 502 pp. Cloth, $4.50. 

SPECIMEN OF ILLTTSTBATIONS. 




Ducts and Acini of the Mammary Organs. 

" If the remaining portions of this work are compiled with the same care and 
accuracy, the whole may vie with any of those that have of late years been pro- 
duced in our own or in foreign languages.'.' — British and Foreign Medico- Chirurgi- 
cal Review. 

" As a book of general information it will be found useful to the practitioner, 
and, as a book of reference, invaluable in the hands of the anatomist and physi- 
ologist." — Dublin Quarterly Journai of Medical Science. 

" The complete work will prove a valuable addition to our systematic treatises 
on human physiology." — The Lancet. 

" To those who desire to get in one volume a concise and clear, and at the 
same time sufficiently full resume of ' the existing state of physiological science,' 
we can heartily recommend Dr. Flint's work. Moreover, as a work of typographi- 
cal art it deserves a prominent place upon our library-shelves. Messrs. Appleton 
& Co. deserve the thanks of the profession for the very handsome style in which 
they issue medical works. They give us hope of a time when it will be very 
generally believed by publishers that physicians' eyes are worth saving." — Medi- 
cal Gazette. 



D. Appleton & CoSs Medical Publications. 



FlintS Physiology. Volume IL. — Alimenta- 
tion; Digestion; Absorption; Lymph and Chyle. 

8vo. 556 pp> Cloth, 84.50. 

" The second instalment of this work fulfils all the expectations raised by the 
perusal of the first. . . . The author's explanations and deductions bear 
evidence of much careful reflection and study. . . . The entire work is one 
of rare interest. The author's style is as clear and concise as his method is 
studious, careful, and elaborate." — Philadelphia Inquirer. 

" We regard the two treatises already issued as the very best on human physi- 
ology which the English or any other language affords, and we recommend them 
with thorough confidence to students, practitioners, and laymen, as models of 
literary and scientific ability." — jtV. Y. Medical Journal. 

" We have found the style easy, lucid, and at the same time terse. The prac- 
tical and positive results of physiological investigation are succinctly stated, 
without, it would seem, extended discussion of disputed points." — Boston Medical 
and Surgical Journal. 

" It is a volume which will be welcome to the advanced student, and as a 
work of reference." — The Lancet. 

" The leading subjects treated of are presented in distinct parts, each of which 
is designed to be an exhaustive essay on that to which it refers." — Western Jour- 
nal of Medicine. 

Volume III. — Secretion ; Excretion ; Ductless Glands ; Nu- 
trition ; Animal Heat ; Movements ; Voice and Speech. 
8vo. 526 pp. Cloth, $4.50. 

" Dr. Flint's reputation is sufficient to give a character to the book among the 
profession, where it will chiefly circulate, and many of the facts given have been 
verified by the author in his laboratory and in public demonstrations." — Chicago 
Courier. 

" The author bestows judicious care and labor. Facts are selected with dis- 
crimination, theories critically examined, and conclusions enunciated with com- 
mendable clearness and precision." — American Journal of the Medical Sciences. 

" The work is calculated to attract other than professional readers, and is 
written with sufficient clearness and freedom from technical pedantry to be per- 
fectly intelligible to any well-informed man." — London Saturday Review. 

" From the extent of the author's investigations into the best theory and prac- 
tice of the present day, the world over, and the candor and good judgment which 
he brings to bear upon the discussion of each subject, we are justified in regarding 
his treatises as standard and authoritative, so far as in this disputed subject 
authority is admissible. — New York Times. 

Volume IV. — The Nervous System. 

This volume is now ready. It is a work of great interest, and, in 
conjunction with the " Treatise on Diseases of the Nervous System," by 
Dr. Wm. A. Hammond, constitutes a complete work on " The Physiology 
and Pathology of the Nervous System." 

Volume V. — Generation. {In press) 



D. Appleton & Co. 9 8 Medical Publications. 

■ — — — — — — ■ s_ 

FLINT. 
Manual of Chemical Examination of 

the Urine in Disease. With Brief Directions for the 
Examination of the most Common Varieties of Uri- 
nary Calculi. 

By AUSTIN FLINT, Je., M. D., 

Professor of Physiology and Microscopy in the Bellevue Hospital Medical College ; Fellow of the 
New York Academy of Medicine ; Member of the Medical Society of the County of New 
York ; Resident Member of the Lyceum of Natural History in the City of New York, etc. 

Third Edition, revised and corrected. 1 vol., 12mo. 77 pp. Cloth, $1.00. 

The chief aim of this little work is to enable the busy practitioner to 

make for himself, rapidly and easily, all ordinary examinations of Urine; 

to give him the benefit of the author's experience in eliminating little 

difficulties in the manipulations, and in reducing processes of analysis 

to the utmost simplicity that is consistent with accuracy. 

" We do not know of any work in English so complete and handy as the 
Manual now offered to the profession by Dr. Flint, and the high scientific reputa- 
tion of the author is a sufficient guarantee of the accuracy of all the directions 
given." — Journal of Applied Chemistry. 

" We can unhesitatingly recommend this Manual." — Psychological Journal. 

" Eminently practical." — Detroit Review of Medicine. 

On the Physiological Effects of Severe 

and Protracted Muscular Exercise. With Special Ref- 
erence to its Influence upon the Excretion of Nitrogen. 
By AUSTIN FLINT, Je., M.D., 

Professor of Physiology in the Bellevue Hospital Medical College, New York, etc., etc 

1 vol., 8vo. 91 pp. Cloth, $2.00. 
This monograph on the relations of Urea to Exercise is the result of 
a thorough and careful investigation made in the case of Mr. Edward 
Payson Weston, the celehrated pedestrian. The chemical analyses were 
made under the direction of R. O. Doremus, M. D., Professor of Chem- 
istry and Toxicology in the Bellevue Hospital Medical Colleg-e, by 
Mr. Oscar Loew, his assistant. The observations were made with the 
cooperation of J. 0. Dalton, M. D., Professor of Physiology in the Col- 
lege of Physicians and Surgeons ; Alexander B. Mott, M. D., Professor 
of Surgical Anatomy; W. H. Van Buren, M. D., Professor of Principles 
of Surgery ; Austin Flint, M. D., Professor of the Principles and Prac- 
tice of Medicine; W. A. Hammond, M. D., Professor of Diseases of the 
Mind and Nervous System — all of the Bellevue Hospital Medical College. 

" This work will be found interesting to every physician. A number of im- 
portant results were obtained valuable to the physiologist." — Cin. Med. Repertory. 



D. Applet on <& Co.'s Medical Publications. 

HAMMOND. 

A Treatise on Diseases of the Nervous 

System. 

By WILLIAM A. HAMMOND, M. D., 

Professor of Diseases of the Mind and Nervous System, and of Clinical Medicine, in the Bellevue 
Hospital Medical College : Physician-in-Chief to the New York State Hospital for Diseases 
of the Nervous System, etc., etc. 

SECOND EDITION, EEVISED AND CORRECTED. 

With Forty-five Illustrations. 1 vol., 8vo. 750 pp. Cloth, $5.00. 

The treatise embraces an introductory chapter, which relates to the 
instruments and apparatus employed in the diagnosis and treatment of 
diseases of the nervous system, and five sections. Of these, the first 
treats of diseases of the brain ; the second, diseases of the spinal cord ; 
the third, cerebro-spinal diseases ; the fourth, diseases of nerve-cells ; 
and the fifth, diseases of the peripheral nerves. One feature which may 
be claimed for the work is, that it rests, to a great extent, upon the per- 
sonal observation and experience of the author, and is therefore no mere 
compilation. 



" The author's clear and terse style of diction renders the book exceedingly 
readable, and the cases reported and cited add much to the interest of the text. 
. . . There is so much that is entertaining in the mental and other manifesta- 
tions of nervous disorder, especially when presented as they are here, that a work 
of this kind will find many readers outside the profession ; and, it may be hoped, 
will serve not only to interest and amuse, but to induce a closer observance of 
those hygienic laws upon whose violation many of the ailments here treated of 
depend." — Neva York Medical Journal. 

" The work is replete with useful knowledge, and every physician who expects 
to be called on, as an expert, to testify in cases of supposed insanity, after the 
commission of crimes, should give the book a thorough perusal" — Leavenworth 
Medical Herald. 

" That a treatise by Prof. Hammond would be one of a high order was what 
we anticipated, and it affords us pleasure to state that our anticipations bave 
been realized." — Cincinnati Medical Repertory. 

" It affords a vast amount of information, is captivating, and worth reading." 
— Cincinnati Lancet and Observer. 

" This is unquestionably the most complete treatise on the diseases to which 
it is devoted that has yet appeared in the English language ; and its value is 
much increased by the fact that Dr. Hammond has mainly based it on his own 
experience and practice, which, we need hardly remind our readers, have been 
very extensive." — London Medical Times and Gazette. 

"Free from useless verbiage and obscurity, it is evidently the work of a 
man who knows what he is writing about, and knows how to write about it"— 
Chicago Medical Journal 



D. Appleton & CoSs Medical Publications. 

HOLLAND. 
Recollections of Past Life, 

By SIR HENRY HOLLAND, Bart., M. D., F. R. S., K. C. B., etc., 
President of the Royal Institution of Great Britain, Physician-in-Ordinary to the Queen, 

etc., etc. 

1 vol., 12mo, 351 pp. Price, Cloth, $2.00. 

A very entertaining and instructive narrative, partaking somewhat of the nature of 
autobiography and yet distinct from it, in this, that its chief object, as alleged by the 
writer, is not so much to recount the events of his own life, as to perform the office of 
chronicler for others with whom he came in contact and was long associated. 

The "Life of Sir Henry Holland " is one to be recollected, and he has not erred in giv- 
ing an outline ot it to the public." — The Lancet. 

"His memory was— is, we may say, for he is still alive and in possession of all his 
faculties — stored with recollections of the most eminent men and women of this cen- 
tury. ... A life extending over a period of eighty-four years, and passed in the most 
active manner, in the midst of the best society, which the world has to offer, must neces- 
sarily be full of singular interest; and Sir Henry Holland has fortunately not waited until 
his memory lost its freshness before recalling some of the incidents in it." — The New 
York Times. 



HOWE. 
Emergencies, and How to Treat Them. 

The Etiology, Pathology, and Treatment of Accidents, 
Diseases, and Gases of Poisoning, which demand 
Prompt Attention. Designed for Students and Prac- 
titioners of Medicine. 

By JOSEPH W. HOWE, M. D., 

Visiting Surgeon to Charity Hospital ; Lecturer on Surgery in the Medical Department of 
the University of New York, etc. 

1 vol., 8vo. 265 pp. Cloth, $3.00. 

This volume is designed as a guide in the treatment of cases of emergency occurring in 
medical, surgical, or obstetrical practice. It combines all the important subjects, giving 
special prominence to points of practical interest in preference to theoretical considera- 
tions, and uniting, with the results of personal observation, the latest views of European 
and American authorities. 

" The style is concise, perspicuous, and definite. Each article is written as though that 
particular emergency were present; there is no waste of words, nor temporizing with 
remedies of doubtful efficacy. The articles on oedema clottidis.a^phvxin. and stran<:olated 
hernia, are particularly clear and practical, and furnish all the information required in the 
management of those urgent cases, 

"It will be found invaluable to students and voumr practitioners, in supplying them 
with an epitome of useful knowledge obtainable from no other single work: while to the 
older members of the profession it will serve as a reliable and ' ready remembrancer.'' "— 
The Medical Record. 



D. Applet on <& CoSs Medical Publications. 

HUXLEY AND YOUMANS. 
The Elements of Physiology and 

Hygiene. With Numerous Illustrations. 

By THOMAS H. HUXLEY, LL. D., F. S. S., and 

WILLIAM JAY YOUMANS, M.D. 

1 vol., 12mo. 420 pp. $1.75. 

A text-book for educational institutions, and a valuable elementary 
work for students of medicine. The greater portion is from the pen of 
Professor Huxley, adapted by Dr. Youmans to the circumstances and 
requirements of American education. 

" A valuable contribution to anatomical and physiological science." — Religious 



A clear and well-arranged work, embracing the latest discoveries and ac- 
cepted theories." — Buffalo Commercial. 

" Teeming with information concerning the human physical economy." — 
Evening Journal. 

HUXLEY. 
The Anatomy of Vertebrated Animals, 

By THOMAS HENRY HUXLEY, LL. D., F. R. S., 

Author of "Man's Place in Nature, 11 "On the Origin of Species, 11 " Lay Sermons and 

Addresses, 11 etc. 

1 vol., 12mo. Cloth, $2.00. 

The former works of Prof. Huxley leave no room for doubt as to the impor- 
tance and value of his new volume. It is one which will be very acceptable to all 
who are interested in the subject of which it treats. 

SPECIMEN Or ILLUSTKATION8. 




The Alligator Terrapene (Chelydra Serpentina). 



"This long-expected work will be cordially welcomed by all students and teachers of 
Comparative Anatomy as a compendious, reliable, and, notwithstanding its small dimen- 
sions, most comprehensive guide on the subject of which it treats. To praise or to criti- 
cise the work of so accomplished a master of his favorite science would be equally ont of 
glace. It is enough to say that it realizes, in a remarkable degree, the anticipations which 
ave been formed of it; and that it presents an extraordinary combination of wide, gen- 
eral views, with the clear, accurate, and succinct statement of a prodigious number of 
individual facts. 11 — Nature. 



D. Appleton & Co.'s Medical Publications. 

JOHNSON. 
The Chemistry of Common Life. 

Illustrated with numerous Wood Engravings. 
By JAMES F. JOHNSON, M. A., F. E. S., F. G. S., etc., etc., 

A.uthor of " Lectures on Agricultural Chemistry and Geology," " A Catechism of Agricultural 
Chemistry and Geology," etc. 

2 vols., 12mo. Cloth, $3.00. 

It lias been the object of the author in this work to exhibit the 

present condition of chemical knowledge, and of matured scientific 

opinion, upon the subjects to which it is devoted. The reader will not 

be surprised, therefore, should he find in it some things which differ 

from what is to be found in other popular works already in his hands or 

on the shelves of his library. 

LETTERMAN. 
Medical Recollections of the Army of 

the Potomac. 

By JONATHAN LETTERMAN, M. D., 

Late Surgeon U. S. A., and Medical Director of the Army of the Potomac. 
1 vol., 8vo. 194 pp. Cloth, $1.00. 
" This account of the medical department of the Army of the Poto- 
mac has been prepared, amid pressing engagements, in the hope that 
the labors of the medical officers of that army may be known to an in- 
telligent people, with whom to know is to appreciate ; and as an affec 
tionate tribute to many, long my zealous and efficient colleagues, who, 
in days of trial and danger, which have passed, let us hope never to re- 
turn, evinced their devotion to their country and to the cause of hu- 
manity, without hope of promotion or expectation of reward." — Preface. 

" We venture to assert that but few who open this volume of medical annals, 
pregnant as they are with instruction, will care to do otherwise than finish them 
at a sitting." — Medical Record. 

" A graceful and affectionate tribute." — N. Y. Medical Journal. 

LEWES. 
The Physiology of Common Life. 

By GEORGE HENRY LEWES, 

Author of " Seaside Studies," "Life of Goethe," etc. 

2 vols., 12mo. Cloth, $3.00. 

The object of this work differs from that of all others on popular 

science in its attempt to meet the wants of the student, while meeting 

those of the general reader, who is supposed to be wholly unacquainted 

with anatomy and physiology. 



P. Appleton & Co.'s Medical Publications. 

MAUDSLEY. 
The Physiology and Pathology of the 

Mind. 

By HENRY MAUDSLEY, M. D., Lo:tdo*t, 

Physician to the "West London Hospital; Honorary Member of the Medico-Psychological Society 
of Paris ; formerly Eesident Physician of the Manchester Royal Lunatic Hospital, etc. 

1 vol., 8vo. 442 pp. Cloth, $3.50. 

This work aims, in the first place, to treat of mental phenomena from 
a physiological rather than from a metaphysical point of view ; and, 
secondly, to bring the manifold instructive instances presented by the 
unsound mind to bear upon the interpretation of the obscure problems 
of mental science. 

" Dr. Maudsley has had the courage to undertake, and the skill to execute, 
what is, at least in English, an original enterprise." — London Saturday Review. 

" It is so full of sensible reflections and sound truths that their wide dissemi- 
nation could not but be of benefit to all thinking persons." — PsychologicalJournal. 

" Unquestionably one of the ablest and most important works on the subject 
of which it treats that has ever appeared, and does credit to his philosophical 
acumen and accurate observation." — Medical Record. 

" We lay down the book with admiration, and we commend it most earnestly 
to our readers as a work of extraordinary merit and originality — one of those 
productions that are evolved only occasionally in the lapse of years, and that 
serve to mark actual and very decided advances in knowledge and science." — 
N. Y. Medical Journal. 



Body 



and JVlincl \ An Inquiry into their Con- 
nection and Mutual Influence, specially in reference 
to Mental Disorders ; being the Gulstonian lectures 
for 1870, delivered before the Royal College of 
Physicians. With Appendix. 

By HENKY MAUDSLEY, M. D., Loot>ok, 

Fellow of the Royal College of Physicians ; Professor of Medical Jurisprudence in University Col- 
lege, London ; President-elect of the Medico-Psychological Association ; Honorary Member of 
the Medico-Psychological Society of Paris, of the Imperial Society of Physicians of Vienna, 
and of the Society for the Promotion of Psychiatry and Forensic Psychology of Vienna ; 
formerly Resident Physician of the Manchester Royal Lunatic Asylum, etc., etc. 

1 vol., 12mo. 155 pp. Cloth, $1.00. 

The general plan of this work may be described as being to bring 
man, both in his physical and mental relations, as much as possible with- 
in the scope of scientific inquiry. 

" A representative work, which every one must study who desires to know 
what is doing in the way of real progress, and not mere chatter, about mental 
physiology and pathology." — The Lancet. 

"It distinctly marks a step in the progress of scientific psychology." — The 
Practitioner. 



D. Appleton & Co. 's Medical Publications. 

MARKOE. 

A Treatise on Diseases of the Bones. 

By THOMAS M. MARKOE, M. D., 
Professor of Surgery in the College of Physicians and Surgeons, New York, etc, 

WITH NUMEROUS ILLUSTRATIONS. 

1 vol. 870. Cloth, §4.50. 

SPECIMEN OF ILLUSTRATIONS. 




This valuable work is a treatise on Diseases of the Bones, embracing their 
structural changes as affected by disease, their clinical history and treatment, in- 
cluding also an account of the various tumors which grow in or upon them. 
None of the injuries of bone are included in its scope, and no joint diseases, ex- 
cepting where the condition of the bone is a prime factor in the problem of 
disease. As the work of an eminent surgeon of large and varied experience, it 
may be regarded as the best on the subject, and a valuable contribution to medi- 
cal literature. 



"The book which I now offer to my professional brethren contains the substance of 
the lectures which I have delivered during the past twelve years at the college. ... I 
have followed the leadings of my own studies and observations, dwelling more on those 
branches where I had seen and studied most, and perhaps too much neglecting others 
where my own experience was more barren, and therefore to me less interesting. I have 
endeavored, however, to make up the deficiencies of my own knowledge by the free use of 
the materials scattered so richly through our periodical literature, which scattered 
leaves it is the right and the duty of the systematic writer to collect and to embody in 
any account he may offer of the state of a science at any given period. ,: — Extract from 
Author's Preface. 



D. Appleton & CoSs Medical Publications. 

MEYER. 
Electricity in its Relations to Practical 

Medicine. 

By De. MORITZ MEYER, 

Eoyal Counsellor of Health, etc. 

Translated from the Third German Edition, with Notes and Additions, 
A New and Revised Edition, 

By WILLIAM A. HAMMOND, M. D., 

Professor of Diseases of the Mind and Nervous System, and of Clinical Medicine, in the Bellevue 
Hospital Medical College; Yice-President of the Academy of Mental Sciences, National 
Institute of Letters, Arts, and Sciences ; late Surgeon-General U. S. A., etc. 

1 vol., 8vo. 497 pp. Cloth, $4.50. 
"It is the duty of every physician to study the action of electricity, 
to become acquainted with its value in therapeutics, and to follow the 
improvements that are being made in the apparatus for its application in 
medicine, that he may be able to choose the one best adapted to the 
treatment of individual cases, and to test a remedy fairly and without 
prejudice, which already, especially in nervous diseases, has been used 
with the best results, and which promises to yield an abundant harvest 
in a still broader domain." — From Author' 8 Preface. 

SPECIMEN of illustrations. 




Saxton-Ettinghausen Apparatus. 

" Those who do not read German are under great obligations to William A. 
Hammond, who has given them not only an excellent translation of a most^ ex- 
cellent work, but has given us much valuable information and many suggestions 
from his own personal experience."— Medical Record. 

" Dr. Moritz Meyer, of Berlin, has been for more than twenty years a laborious 
and conscientious student of the application of electricity to practical medicine, 
and the results of his labors are given in this volume. Dr. Hammond, in making 
a translation of the third German edition, has done a real service to the profession 
of this country and of Great Britain. Plainly and concisely written, and simply 
and clearly arranged, it contains just what the physician wants to know on the 
subject." — N. T. Medical Journal. 

" It is destined to fill a want long felt by physicians in this country."— Journal 
of Obstetrics. 



D. Appleton & Oo.'s Medical Publications. 

NIEMETER. 

A Text-Book of Practical Medicine. 

With Particular Reference to Physiology and Patho- 
logical Anatomy. 

By the late Dr. FELIX YON NTEMEYER, 

Professor of Pathology and Therapeutics ; Director of the Medical Clinic of the University of 

Tubingen. 

Translated from the Eighth German Edition, toy special permission of 

the Author, 

By GEOEGE H. HUMPHREYS, M. D., 

Late one of the Physicians to the Bureau of Medical and Surgical Relief at Bellevue Hospital for 
the Out-door Poor ; Fellow of the New York Academy of Medicine, etc., 

and 
CHARLES E. HACKLEY, M. D., 

One of the Physicians to the New York Hospital ; one of the Surgeons to the New York Eye 
and. Ear Infirmary ; Fellow of the New York Academy of Medicine, etc. 

Bevised Edition. 2 vols., 8vo. 1,528 pp. Cloth, $9.00 ; Sheep, $11.00. 

The author undertakes, first, to give a picture of disease which shall 
be as lifelike and faithful to nature as possible, instead of being a mere 
theoretical scheme ; secondly, so to utilize the more recent advances 
of pathological anatomy, physiology, and physiological chemistry, as to 
furnish a clearer insight into the various processes of disease. 

The work has met with the most flattering reception and deserved 
success ; has been adopted as a text-book in many of the medical colleges 
both in this country and in Europe; and has received the very highest 
encomiums from the medical and secular press. 

" It is comprehensive and concise, and is characterized by clearness and 
originality." — Dublin Quarterly Journal of Medicine. 

" Its author is learned in medical literature ; he has arranged his materials 
with care and judgment, and has thought over them." — The Lancet. 

"As a full, systematic, and thoroughly practical guide for the student and 
physician, it is not excelled by any similar treatise in any language." — Appleions' 
Journal. 

" The author is an accomplished pathologist and practical physician ; he is not 
only capable of appreciating the new discoveries, which during the last ten years 
have been unusually numerous and important in scientific and practical medicine, 
but, by his clinical experience, he can put these new views to a practical test, and 
give judgment regarding them." — Edinburgh Medical Journal. 

" From its general excellence, we are disposed to think that it will soon take 
its place among the recognized text-books." — American Quarterly Journal of 
Medical Sciences. 

" The first inquiry in this country regarding a German book generally is, ' Is 
it a work of practical value ? " Without stopping to consider the justness of the 
American idea of the ' practical,' we can unhesitatingly answer, * It is ! * " — New 
York Medical Journal. 

" The author has the power of sifting the tares from the wheat — a matter of 
the greatest importance in a text-book for students." — British Medical Journal. 

" Whatever exalted opinion our countrymen may have of the author's talents 
of observation and his practical good sense, his text-book will not disappoint 
them, while those who are so unfortunate as to know him only by name, have in 
store a rich treat." — New York Medical Record, 



D. Appleton 6b CoSs Medical Publications. 

NEUMANN. 
Hand-Book of Skin Diseases. 

By Dr. ISIDOR NEUMANN, 

Lecturer on Skin Diseases in the Koyal University of Vienna. 

Translated from advanced sheets of the second edition, furnished by the 
Author ; with Notes, 

By LUCIUS D. BULKLEY, A. M., M. D., 

Surgeon to the New York Dispensary, Department of Venereal and Skin Diseases ; Assist- 
ant to the Skin Clinic of the College of Physicians and Surgeons, New York; Mem- 
ber of the New York Dermatological Society, etc., etc. 

1 vol., 8vo. About 453 pages and 66 Woodcuts. Cloth, $4.00. 

SPECEilEN OF ILLUSTRATIONS. 




Section of skin from a bald head. 

Prof. Neumann ranks second only to Hebra, whose assistant he was for many years, 
and his work may be considered as a fair exponent of the German practice of Dermatolo- 
gy. The book is abundantly illustrated with plates of the histology and pathology of the 
skin. The translator has endeavored, by means of notes from French, English, and Ameri- 
can sources, to make the -work valuable to the student as well as to the practitioner. 

"It is a work which I shall heartily recommend to my class of students at the Univer- 
sity of Pennsylvania, and one which I feel sure will do much toward enlightening the pro- 
fession on this subject. 1 ' — Louis A. Duhring. 

" I know it to be a good book, and I am sure that it is well translated ; and it is inter- 
esting to find it illustrated by references to the views of co-laborers in the same field."— 
Erasmus Wilson. 

" So complete as to render it a most useful book of reference. ,, — T. McCaU Anderson. 

"There certainly is no work extant which deals so thorouffhly with the Pathological 
Anatomy of the Skin as does this hand-book."— N. Y. Medical Record. 

" The original notes by Dr. Bulkley are very practical, and are an important adjunct to 
the text. . . . I anticipate for it a wide circulation. "— Silas DvrJcee. Boston. 

"I have already twice expressed my favorable opinion of the book in print, and am 
glad that it is given to the public at last."— James C. White, Boston. 

"More than two years ago we noticed Dr. Neumann's admirable work in its original 
shape ; and we are therefore absolved from the necessity of saying more than to repeat 
our stroDg recommendation of it to English readers."— Practitioner. 



D. Appleton & CoSs Medical Publications. 



NEFTEL. 

GalvailO -Therapeutics. The Physiological and 
Therapeutical Action of the Galvanic Current upon 
the Acoustic, Optic, Sympathetic, and Pneumogastric 

Nerves. 

By WILLIAM B. NEFTEL. 

1 vol., 12mo. 161 pp. Cloth, $1.50. 

This book has been published at the request of several aural surgeons 
and other professional gentlemen, and is a valuable treatise on the sub- 
jects of which it treats. Its author, formerly visiting physician to the 
largest hospital of St. Petersburg, has had the very best facilities for in- 
vestigation. 

"This little work shows, as far as it goes, full knowledge of what has been 
done on the subjects treated of, and the author's practical acquaintance with 
them." — New York Medical Journal. 

"Those who use electricity should get this work, and those who do not 
should peruse it to learn that there is one more therapeutical agent that they 
could and should possess." — The Medical Investigator. 



NIGHTINGALE. 
Notes OI1 Nursing : What it is, and what it is not 

By FLORENCE NIGHTINGALE. 

1 vol., 12mo, 140 pp. Cloth, 75 cents. 

Every day sanitary knowledge, or the knowledge of nursing, or, in 
other words, of how to put the constitution in such a state as that it will 
have no disease or that it can recover from disease, takes a higher place. 
It is recognized as the knowledge which every one ought to have— dis- 
tinct from medical knowledge, which only a profession can have. 



D. Appleton <Sb CoSs Medical Publications. 



PEASLEE. 
A Treatise on Ovarian Tumors. Their 

Pathology, Diagnosis, and Treatment, with reference 
especially to Ovariotomy. 

By EDMUND R. PEASLEE, M. D., LX. D., 

Professor of Diseases of Women, in Dartmouth College : one of the Consulting Surgeons 
to the N. Y. State Woman's Hospital; formerly Professor of Obstetrics and Diseases 
of Women, in the N. Y. Medical College: Corresponding Member of the Obstetrical 
Society of Berlin, etc. 

In oris large vol., 8vo., with Illustrations. 

SPECIMEN OF rXLTTSTEATIONS. 




Syeinge foe Exploeation of Ovaeian Cysts. 

A, instrument, 5% inches long ; B, gilded tube, 3 inches long, and ^ to ^ inch in diameter, 
with bevelled point ; jB 1 , similar tube, A% inches long ; (7, rubber tube, to be attached to arm 
a, by which the fluid, drawn from the cyst through a\ is forced out. The stop-cocks at a 
and a? are both shown as closed. 

This valuable work, embracing the results of many years of successful ex- 
perience, in the department of which it treats, will prove most acceptable to the 
entire profession ; while the high standing of the author and his knowledge of 
the subject combine to make the book the best in the language. It is divided 
into two parts : the first, treating of Ovarian Tumors, their anatomy, pathology, 
diagnosis, and treatment, except by extirpation ; the second, of Ovariotomy, its 
history and statistics, and of the operation. Fully illustrated, and abounding with 
information the result of a prolonged study of the subject, the work should be 
in the hands of every physician in the country. 



D. Appleton <fc Co.'s Medical Publications. 

STROUD. 
The Physical Cause of the Death of 

Christ, and its Relations to the Principles and Prac- 
tice of Christianity. 

By WILLIAM STROUD, M. D., 

With a Letter on the Subject, 

By Sir JAMES Y. SIMPSON, Bart.,M.D. 

1 vol., 12mo. 422 pp. Cloth, $2.00. 

This important and remarkable book is, in its own place, a masterpiece, and 
will be considered as a standard work for many years to come. 

The principal point insisted tipon is, that the death of Christ was caused by rupture 
or laceration of the heart. Sir James Y. Simpson, who had read the author's treatise 
and various comments on it, expressed himself very positively in favor of the views 
maintained by Dr. Stroud."— Psychological Journal. 

SWETT. 

A Treatise on the Diseases of the Chest. 

Being a Course of Lectures delivered at the New 
York Hospital. 

By JOHN A. SWETT, M. D., 

Professor of the Institutes and Practice of Medicine in the New York University; Physi- 
cian to the New York Hospital; Member of the New York Pathological Society. 

1 vol., 8vo. 587 pp. $3.50. 

Embodied in this volume of lectures, is the experience of ten years in hospital 
and private practice. 

SAYRE. 
A Practical Manual on the Treatment 

of Club-Foot. 

By LEWIS A. SAYRE, M. D., 

Professor of Orthopedic Surgery in Bellevue Hospital Medical College; Surgeon to Belle- 
vue and Charity Hospitals, etc. 

1 vol., 12mo. 91 pp. Cloth, $1.00. 
" The object of this work is to convey, in as concise a manner as possible, all 
the practical information and instruction necessary to enable the general prac- 
titioner to apply that plan of treatment which has been so successful in my own 
hands." 

" Tbe book will very well satisfy the wants of the majority of general practitioners* 
for whose use, as stated, it is intended."— New York Medical Journal. 



D. Appleton & CoSs Medical Publications. 



SIMPSON. 
The Posthumous Works of Sir James 

Young Simpson, Bart., M. D. In Three Volumes. 

Volume I. — Selected Obstetrical and Gynaecological Works of 
Sir James Y. Simpson, Bart., M. D., D. C. L., late Professor of Midwifery in 
the University of Edinbugh. Containing the substance of his Lectures on 
Midwifery. Edited by J. Watt Black, A. M., M. D., Member of the Royal 
College of Physicians, London; Physician- Accoucheur to Charing Cross 
Hospital, London; and Lecturer on Midwifery and Diseases of Women and 
Children in the Hospital School of Medicine. 

1 vol., 8vo. 852 pp. Cloth, $3.00. 

This volume contains all the more important of the contributions of 
Sir James Y. Simpson to the study of obstetrics and diseases of women, 
with the exception of his clinical lectures on the latter subject, which 
will shortly appear in a separate volume. This first volume contains 
many of the papers reprinted from his Obstetric Memoirs and Contri- 
butions, and also his Lecture Notes, now published for the first time, 
containing the substance of the practical part of his course of midwifery. 
It is a volume of great interest to the profession, and a fitting memorial 
of its renowned and talented author. 

" To many of our readers, doubtless, the chief of the papers it contains are 
familiar. To others, although probably they may be aware that Sir James Simp- 
son has written on the subjects, the papers themselves will be new and fresh. 
To the first class, we would recommend this edition of Sir James Simpson's works, 
as a valuable volume of reference ; to the latter, as a collection of the works of a 
great master and improver of his art, the study of which caunot fail to make them 
better prepared to meet and overcome its difficulties." — Medical Times and Gazette. 

Volume II. — Anaesthesia, Hospitalism, etc. Edited by Sir 
Walter Simpson, Bart. 

1 vol., 8vo. 560 pp. Cloth, $3.00. 

" We say of this, as of the first volume, that it should find a place on the table 
of every practitioner ; for, though it is patchwork, each piece may be picked out 
and studied with pleasure and profit." — The Lancet {London). 

Volume III. — The Diseases of Women. Edited by Alex. Simp- 
son, M. D., Professor of Midwifery in the University of Edinburgh. 

1 vol., 8vo., Cloth, $3.00. 

One of the best works on the subject extant. Of inestimable value to every 
physician. 



D. Appleton & CoSs Medical Publications. 

TILT. 
A Hand-Book of Uterine Therapeu- 

tics and of Diseases of Women. 

By EDWARD JOHN TILT, M. D., 

Member of the Eoyal College of Physicians ; Consulting Physician to the Farringdon General 
Dispensary ; Fellow of the Eoyal Medical and Chirurgical Society, and of several British and 
foreign societies. 

1 vol., 8vo. 345 pp. Cloth, $3.50. 

Second American edition, thoroughly revised and amended. 

The main points developed in this work are : 

1. The paramount importance of hygiene for the relief and cure of 
diseases of women. 

2. The constitutional nature of many diseases of women, and the 
impossibility of curing them without constitutional remedies. 

3. The manifest reaction of uterine diseases on the female system, 
and the impossibility of curing many uterine complaints, without surgi- 
cal measures. 

4. The great value of therapeutics to assuage and cure diseases of 
women, and the belief in the value of those remedial measures that are 
as old as medicine itself, such as venesection, emetics, and caustics. 

"In giving the result of his labors to the profession the author has done a 
great work. Our readers will find its pages very interesting, and, at the end of 
their task, will feel grateful to the author for many very valuable suggestions as 
to the treatment of uterine diseases." — The Lancet. 

" Dr. Tilt's ' Hand-book of Uterine Therapeutics ' supplies a want which has 
often been felt. ... It may, therefore, be read not only with pleasure and 
instruction, but will also be found very useful as a book of reference." — The 
Medical Mirror. 

" Second to none on the therapeutics of uterine disease." — Journal of Ob- 
stetrics. 

VAN BTJKEN. 
Lectures upon Diseases of the Rectum. 

Delivered at the Bellevue Hospital Medical College. 
Session of 1869~'70. 

By W. H. VAN BUREN, M. D., 

Professor of the Principles of Surgery with Diseases of the Genito-Urinary Organs, etc., in the 
Bellevue Hospital Medical College ; one of the Consulting Surgeons of the New York Hos- 
pital, of the Bellevue Hospital ; Member of the New York Academy of Medicine, of the 
Pathological Society of New York, etc., etc. 

1 vol., 12mo. 164 pp. Cloth $1.50. 
Lecture I. — Pruritus Ani, Hemorrhoids, etc. II. — Internal Haemor- 
rhoids. III. — Polypus, IV. — Fistula in Ano. V. — Fissure, or Irritable 
Ulcer. VI. — Stricture of the Rectum. VII. — Cancer. VIII. — Diagno- 
sis, etc. 

" It seems hardly necessary to more than mention the name of the author of 
this admirable little volume in order to insure the character of his book. No 
one in this country has enjoyed greater advantages, and had a more extensive 
field of observation in this specialty, than Dr. Van Buren, and no one ha9 paid 
the same amount of attention to the subject. . . . Here is the experience 
of years summed up and given to the professional world in a plain and practical 
manner." — Psychological Journal. 



D. Appleton <£ Co.'s Medical Publications. 

t^OGEL. 
A Practical Treatise on the Diseases 

of Children. Second American from the Fourth 
German Edition. Illustrated by Six Lithographic 
Plates. 

By ALFRED VOGEL, M. D., 

Professor of CBnical Medicine In the University of Dorpat, Bussia. 

TKANSLATED AND EDITED BY 

H. RAPHAEL, M. D., 

Late House Surgeon to Bellevue Hospital ; Physician to the Eastern Dispensary for She Diseases 
of Children, etc., etc 

1 vol., 8vo. 611 pp. Cloth, $4.50. 

The work is well np to the present state of pathological knowledge ; 
complete without unnecessary prolixity; its symptomatology accurate, 
evidently the result of careful observation of a competent and experi- 
enced clinical practitioner. The diagnosis and differential relations of 
diseases to each other are accurately described, and the therapeutics 
judicious and discriminating. All polypharmacy is discarded, and only 
the remedies which appeared useful to the author commended. 

This work of Vogel's contains much that must gain for it the merited 
praise of all impartial judges, and prove it to be an invaluable text-book 
for the student and practitioner, and a safe and useful guide in the diffi- 
cult but all- important department of Paediatrics. 

" Rapidly passing to a fourth edition in Germany, and translated into three 
Other languages, America now has the credit of presenting the first English ver- 
sion of a book which must take a prominent, if not the leading, position among 
works devoted to this class of disease." — N. Y. Medical Journal. 

" The profession of this country are under many obligations to Dr. Raphael 
for bringing, as he has done, this truly valuable work to their notice." — Medical 
Record. 

"The translator has been more than ordinarily successful, and his labors 
have resulted in what, in every "sense, is a valuable contribution to medicai 
science." — Psychological Journal. 

" We do not know of a compact text-book on the diseases of children more 
complete, more comprehensive, more replete with practical remarks and scientific 
facts, more in keeping with the development of modern medicine, and more 
worthy of the attention of the profession, than that which has been the subject 
of our remarks." — Journal of Obstetrics,. 



NEW MEDICAL WORKS IN PRESS. 



On Puerperal Diseases, cunicai inures de- 
livered at Bellevue Hospital, 

By FORDYCE BARKER, M.D., 

Clinical Professor of Midwifery and Diseases of Women irrthe Bellevue Hospital Medical 
College ; Obstetric Physician to Bellevue Hospital; Consulting Physician to the N. Y. 
State Woman's Hospital, and to the N. Y. State Hospital for Diseases of the Nervous 
System ; Honorary Member of the Edinburgh Obstetrical Society, etc., etc. 

A course of lectures valuable alike to the student and the practitioner. 



Hand-Book of the Histology and His- 

to- Chemistry of Man* 

By Dr. HEINRICH FREY, 
of Zurich, 

Illustrated with 500 Woodcuts. 

A Treatise on Obstetrics, with an introduction 

on the Pathology of Rregnancy and Childbirth. 

By Dr. KARL SCHROEDER, 

of the University of Erlangen, Bavaria- 

On Surgical Diseases of the Male Gen- 

ito- Urinary Organs, including Syphilis. 
By W. H. VAN BUREN, M.D., and EDW. L. KEYES, M.D. 

A New Work on the Anatomy, Pathol- 
ogy, and Treatment of Diseases of the Ovaries. 

By T. SPENCER WELLS, M. D., 

Surgeon-in-Ordinary to Iler Majesty's Household ; Surgeon to the Samaritan Hospital for 
Women ; Memher of the ROyal Institutions, etc., etc. 

Chemical Technology. 

By RUDOLF WAGNER. 

Translated by WiL CROOKES, F.R.S. 



THE NEW YOEK MEDICAL JOEENAl. 

JJLS. B. HTTNIEM, M. D., \ Editors. 

Published Monthly. Volumes begin in January and July. 

"Among the numerous records of Medicine and the collateral sciences published iu 
America, the above Journal occupies a high position, and deservedly so."— The Lancet 
{London). 

Terms, $4.00 per Annum. Specimen Copies, 25 Cents. 



-♦♦♦- 



THE JOURNAL OF PSYCHOLOGICAL MBDIGINB : 

A QUARTERLY REVIEW OF 

DISEASES OF THE NERVOUS SYSTEM, MEDICAL JURIS- 
PRUDENCE, AND ANTHROPOLOGY. 

EDITED BT 

WILLIAM A. HAMMOND, M. D. 

" A Quarterly that does honor to the professions to which it is chiefly addressed."— 
New York World. 

Terms, $5.00 per Annum. Specimen Copies^ $1.00. 

THE POPHLAE SCIENCE MONTHLY, 

Conducted by Prof. E. L. Youmans. 
Published Monthly. Each Number contains 128 pages. 

OPINIONS OF THE PRESS. 

" Just the publication needed at the present day."— Montreal Gazette. 

" It is, beyond comparison, the best attempt at journalism of the kind ever made in 
this country." — Home Journal. 

" The initial number is admirably constituted."— Evening Mail. 

" In our opinion, the right idea has been happily hit in the plan of this new monthly. 1 
—Buffalo Courier. 

" A journal which promises to be of eminent value to the cause of popular education in 
this country." — N. Y. Tribune. 

THE POPULAR SCIENCE MONTHLY is published in a large 
octavo , handsomely printed on clear type. Ter?ns, Five dollars per an- 
num, or Fifty Cents per copy. 

New York Medical Journal and Psychological Journal $8 00 

New York Medical Journal and Appletons' Weekly Journal of Literature, Science, 

and Art 7 00 

Psychological Journal and Appletons' Weekly Journal 8 00 

Psychological, Medical, and Weekly Journal 10 00 

Psychological, Medical, Popular Science Monthly, and Weekly Journal 14 50 

flF™ Pay ment, in all cases, must be in advance. 

Remittances should be made by postal money-order or check to the Publishers, 

D. APPLETCN & CO., 549 and 551 Broadway, N. Y. 



